MEDICARE: ALEXIS LANG 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	82508	CA

General Provider Information

NPI Number	:	1487272209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS LANG PHARMD

Provider Business Mailing Address
First Line	:	1941 SILVERWOOD LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3127
Country	:	US
Telephone Number	:	702-241-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD STE 111
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1449
Country	:	US
Telephone Number	:	818-952-2223
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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