MEDICARE: SUNETTE DE LANGE PHARMACIST

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	60747	CA

General Provider Information

NPI Number	:	1801057880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNETTE DE LANGE PHARMACIST

Provider Business Mailing Address
First Line	:	1120 E CLARK AVE
Second Line	:
City	:	ORCUTT
State	:	CA
Zip	:	93455-5123
Country	:	US
Telephone Number	:	805-934-4002
Fax Number	:	805-934-4782

Provider Business Practice Location Address
First Line	:	1120 E CLARK AVE
Second Line	:
City	:	ORCUTT
State	:	CA
Zip	:	93455-5123
Country	:	US
Telephone Number	:	805-934-4002
Fax Number	:	805-934-4782

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

Provider Enumeration Date	:	06/22/2008
Last Update Date	:	06/22/2008

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