Provider Demographics
NPI:1881988731
Name:LONGO, LAURA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:LONGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 STATE HIGHWAY 121
Mailing Address - Street 2:T-2142
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8900 STATE HIGHWAY 121
Practice Address - Street 2:T-2142
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2917
Practice Address - Country:US
Practice Address - Phone:972-439-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293595183500000X
TX52675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist