Provider Demographics
NPI:1467587402
Name:LANG, ARTHUR BURNETT (RPH PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:BURNETT
Last Name:LANG
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PALACIOS
Mailing Address - State:TX
Mailing Address - Zip Code:77465
Mailing Address - Country:US
Mailing Address - Phone:361-972-2034
Mailing Address - Fax:361-972-2682
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:PALACIOS PRESCRIPTION SHOPPE
Practice Address - City:PALACIOS
Practice Address - State:TX
Practice Address - Zip Code:77465
Practice Address - Country:US
Practice Address - Phone:361-972-3608
Practice Address - Fax:361-972-2682
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06185OtherSTATE LIC #
TX142181Medicaid