Provider Demographics
NPI:1821688433
Name:LANGE, SHANNON
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6701 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7787
Mailing Address - Country:US
Mailing Address - Phone:410-254-2055
Mailing Address - Fax:
Practice Address - Street 1:6701 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7787
Practice Address - Country:US
Practice Address - Phone:410-254-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician