Provider Demographics
NPI:1831429836
Name:OLONGO, CARL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:OLONGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6503
Mailing Address - Country:US
Mailing Address - Phone:602-243-1525
Mailing Address - Fax:602-243-0328
Practice Address - Street 1:7606 S 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6503
Practice Address - Country:US
Practice Address - Phone:602-243-1525
Practice Address - Fax:602-243-0328
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist