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General NPI Number Information
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NPI Number | 1083114052
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Entity Type | Individual
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Provider Name | SARA LANGE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 2005 FORT WORTH HWY STE 100
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City | WEATHERFORD
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State | TX
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Zip | 76086-4780
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Country | US
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Telephone | 817-953-6604
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Fax | 817-668-7637
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Provider Business Mailing Address
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Address Line | 101 E CORPORATE DR STE 300
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City | LEWISVILLE
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State | TX
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Zip | 75067-6687
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Country | US
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Telephone | 972-299-8990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 61847
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License Number State | SD
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