MEDICARE: DR. SARA LANGE PHARMD

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	61847	SD

General Provider Information

NPI Number	:	1083114052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA LANGE PHARMD

Provider Business Mailing Address
First Line	:	101 E CORPORATE DR STE 300
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-6687
Country	:	US
Telephone Number	:	972-299-8990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 FORT WORTH HWY STE 100
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4780
Country	:	US
Telephone Number	:	817-953-6604
Fax Number	:	817-668-7637

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	11/21/2018

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