Healthcare Provider Details

I. General information

NPI: 1194529586
Provider Name (Legal Business Name): JONATHAN LANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD STE P
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

5760 PATRIOT BLVD STE P
AUSTINTOWN OH
44515-1170
US

V. Phone/Fax

Practice location:
  • Phone: 330-750-7896
  • Fax:
Mailing address:
  • Phone: 330-750-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03445193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: