Provider Demographics
NPI:1750683413
Name:LANG, GLEN D (RPH)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:D
Last Name:LANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4119 BOONSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2340
Mailing Address - Country:US
Mailing Address - Phone:434-384-3669
Mailing Address - Fax:434-384-6924
Practice Address - Street 1:4119 BOONSBORO RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2340
Practice Address - Country:US
Practice Address - Phone:434-384-3669
Practice Address - Fax:434-384-6924
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202004578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist