Healthcare Provider Details

I. General information

NPI: 1053830786
Provider Name (Legal Business Name): ROXANA LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

IV. Provider business mailing address

26000 W LUGONIA AVE APT 4403
REDLANDS CA
92374-5111
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-6943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number4150406
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number57340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: