Provider Demographics
NPI:1417029406
Name:LANG, ALLEN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:C
Last Name:LANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1843
Mailing Address - Country:US
Mailing Address - Phone:715-748-4477
Mailing Address - Fax:715-748-5848
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1843
Practice Address - Country:US
Practice Address - Phone:715-748-4477
Practice Address - Fax:715-748-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8832040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30040200Medicaid
WI0158660001Medicare NSC