Provider Demographics
NPI:1619092673
Name:LANG, ROGER JOHN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:JOHN
Last Name:LANG
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 W ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5011
Mailing Address - Country:US
Mailing Address - Phone:978-458-1994
Mailing Address - Fax:978-452-5686
Practice Address - Street 1:777 ROGERS ST
Practice Address - Street 2:HANNAFORD FOOD & DRUG 327
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4336
Practice Address - Country:US
Practice Address - Phone:978-453-7257
Practice Address - Fax:978-452-5686
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA15336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist