Healthcare Provider Details

I. General information

NPI: 1679858286
Provider Name (Legal Business Name): BRIAN E LANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN E LANG RPH

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737ACUSHNET AVE
NEW BEDFORD MA
02745
US

IV. Provider business mailing address

1737ACUSHNET AVE
NEW BEDFORD MA
02745
US

V. Phone/Fax

Practice location:
  • Phone: 508-984-4410
  • Fax:
Mailing address:
  • Phone: 508-984-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number232407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: