Provider Demographics
NPI:1689894966
Name:ARAGON LONGO, JOHMARIS (RPH)
Entity Type:Individual
Prefix:
First Name:JOHMARIS
Middle Name:
Last Name:ARAGON LONGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1347
Mailing Address - Country:US
Mailing Address - Phone:770-435-2544
Mailing Address - Fax:770-437-9974
Practice Address - Street 1:2113 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1347
Practice Address - Country:US
Practice Address - Phone:770-435-2544
Practice Address - Fax:770-437-9974
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist