Healthcare Provider Details

I. General information

NPI: 1801467287
Provider Name (Legal Business Name): MAGDALENA LANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2989
US

IV. Provider business mailing address

10899 SAND RUN RD
HARRISON OH
45030-8946
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2585
  • Fax:
Mailing address:
  • Phone: 513-205-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-26928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: