Provider Demographics
NPI:1225746738
Name:LANG, TAYLOR CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTIAN
Last Name:LANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1446
Mailing Address - Country:US
Mailing Address - Phone:920-210-6630
Mailing Address - Fax:
Practice Address - Street 1:120 FRANCES LN
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1165
Practice Address - Country:US
Practice Address - Phone:920-885-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21478-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist