Provider Demographics
NPI:1922185156
Name:LANG, BARRON
Entity Type:Individual
Prefix:
First Name:BARRON
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W MAIN ST
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4270
Mailing Address - Country:US
Mailing Address - Phone:805-922-3996
Mailing Address - Fax:805-922-9618
Practice Address - Street 1:1115 W MAIN ST
Practice Address - Street 2:SUITE E-1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4270
Practice Address - Country:US
Practice Address - Phone:805-922-3996
Practice Address - Fax:805-922-9618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY47207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0541931OtherNCPDP#
CAPHA472070Medicaid
CA0541931OtherNCPDP#