Healthcare Provider Details

I. General information

NPI: 1700293297
Provider Name (Legal Business Name): LISA MICHELE LANG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16105 CHENAL PKWY STE B
LITTLE ROCK AR
72223-4824
US

IV. Provider business mailing address

16105 CHENAL PKWY STE B
LITTLE ROCK AR
72223-4824
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-7920
  • Fax: 501-217-7922
Mailing address:
  • Phone: 501-217-7920
  • Fax: 501-217-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10982
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: