Provider Demographics
NPI:1376092460
Name:LANG S PHARMACY OF WILTON CENTER LLC
Entity Type:Organization
Organization Name:LANG S PHARMACY OF WILTON CENTER LLC
Other - Org Name:LANG'S PHARMACY OF WILTON CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPRILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-241-4711
Mailing Address - Street 1:28 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3007
Mailing Address - Country:US
Mailing Address - Phone:203-762-6700
Mailing Address - Fax:203-762-6704
Practice Address - Street 1:28 CENTER ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3007
Practice Address - Country:US
Practice Address - Phone:203-762-6700
Practice Address - Fax:203-762-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.0023433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164432OtherPK
CT1376092460Medicaid