Provider Demographics
NPI:1255028965
Name:LONGE, KENNETH G (RPH)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:LONGE
Suffix:
Gender:M
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:URB. JARDINES DE CAGUAS
Mailing Address - Street 2:D6 CALLE E
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-2520
Mailing Address - Country:US
Mailing Address - Phone:787-328-8943
Mailing Address - Fax:
Practice Address - Street 1:URB. JARDINES DE CAGUAS
Practice Address - Street 2:D6 CALLE E
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2520
Practice Address - Country:US
Practice Address - Phone:787-328-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241396183500000X
PR8058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist