Provider Demographics
NPI:1790818789
Name:LANGE, JEAN ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANNE
Last Name:LANGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5628
Mailing Address - Country:US
Mailing Address - Phone:518-377-0697
Mailing Address - Fax:518-374-3325
Practice Address - Street 1:262 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4521
Practice Address - Country:US
Practice Address - Phone:518-384-0246
Practice Address - Fax:518-384-7893
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist