=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467959437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFF LANGFORD PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2018
-----------------------------------------------------
Last Update Date | 04/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1537 WALTON WAY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30904-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-731-1344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 HOLLEY LAKE RD
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29803-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-292-6396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17991
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------