Provider Demographics
NPI:1578965513
Name:LANGEMO, STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:LANGEMO
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 1:1811 OLD HIGHWAY 8 NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1828
Mailing Address - Country:US
Mailing Address - Phone:651-639-0608
Mailing Address - Fax:
Practice Address - Street 1:1811 OLD HIGHWAY 8 NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1828
Practice Address - Country:US
Practice Address - Phone:651-639-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist