Provider Demographics
NPI:1659774248
Name:LONGERICH, MICHAEL HERMANN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HERMANN
Last Name:LONGERICH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40130 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3005
Mailing Address - Country:US
Mailing Address - Phone:661-267-6596
Mailing Address - Fax:661-267-2839
Practice Address - Street 1:40130 10TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3005
Practice Address - Country:US
Practice Address - Phone:661-267-6596
Practice Address - Fax:661-267-2839
Is Sole Proprietor?:No
Enumeration Date:2014-09-27
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist