Healthcare Provider Details

I. General information

NPI: 1093303562
Provider Name (Legal Business Name): WILLIAM WADE LANGLEY II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 YOPP RD STE 200
JACKSONVILLE NC
28540-3594
US

IV. Provider business mailing address

1070 CHADWICK SHORES DR
SNEADS FERRY NC
28460-9268
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-9684
  • Fax: 910-455-0622
Mailing address:
  • Phone: 910-774-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: