Healthcare Provider Details

I. General information

NPI: 1992088025
Provider Name (Legal Business Name): BARBARA LANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SE FEDERAL HWY
STUART FL
34997-7836
US

IV. Provider business mailing address

9031 SE DUNCAN ST
HOBE SOUND FL
33455-6924
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-0551
  • Fax: 772-286-9759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: