Provider Demographics
NPI:1932702271
Name:LANGHAM, TINA MICHELE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELE
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 SHADOWLAWN DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4831
Mailing Address - Country:US
Mailing Address - Phone:239-793-0232
Mailing Address - Fax:239-793-2491
Practice Address - Street 1:2515 SHADOWLAWN DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4831
Practice Address - Country:US
Practice Address - Phone:239-793-0232
Practice Address - Fax:239-793-2491
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0027425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist