Active NPI
Mark Longo, RPH
- Pharmacist
- Page, AZ
National Provider Identifier
1093196859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S012588
- Practice address
- 650 Elm Street
Page, AZ 86040 - Phone
- (928) 645-5714
- Fax
- (928) 645-1286
- NPI assigned
- Jun 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S012588 | AZ | Primary |
Addresses
Primary practice location
650 Elm Street
Page, AZ 86040
Mailing address
650 Elm St
Page, AZ 86040
Phone (928) 645-5714
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S012588 | Other | AZ | PHARMACY LICENSE |
| 151407-1701 | Other | UT | PHARMACY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S012588 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Page, AZ
- NPI 1447289491
-
- Community/Retail Pharmacy
- Queen Creek, AZ
- NPI 1730040973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434499200000",
"number": "1093196859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 ELM ST",
"city": "PAGE",
"state": "AZ",
"postal_code": "86040",
"telephone_number": "928-645-5714",
"fax_number": "928-645-1286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 ELM STREET",
"city": "PAGE",
"state": "AZ",
"postal_code": "86040",
"telephone_number": "928-645-5714",
"fax_number": "928-645-1286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGO",
"first_name": "MARK",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-17",
"last_updated": "2015-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S012588",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "S012588",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "151407-1701",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Page, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.