Provider Demographics
NPI:1760891691
Name:LANGRO, JORDAN JOSEPH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:JOSEPH
Last Name:LANGRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1513
Mailing Address - Country:US
Mailing Address - Phone:631-851-1183
Mailing Address - Fax:
Practice Address - Street 1:1850 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1513
Practice Address - Country:US
Practice Address - Phone:631-851-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist