MEDICARE: WILLIAM JEFFREY LANGDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	029584	MO

General Provider Information

NPI Number	:	1003406125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JEFFREY LANGDON

Provider Business Mailing Address
First Line	:	4409 APPLETREE CT
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3697
Country	:	US
Telephone Number	:	816-387-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 E PRICE AVE
Second Line	:
City	:	SAVANNAH
State	:	MO
Zip	:	64485-1742
Country	:	US
Telephone Number	:	816-324-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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