Provider Demographics
NPI:1457370033
Name:LANGNER, WESLEY JACK (RPH)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JACK
Last Name:LANGNER
Suffix:
Gender:M
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:PO BOX 2267
Mailing Address - Street 2:1422 PASEO DE PERALTA
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2267
Mailing Address - Country:US
Mailing Address - Phone:505-988-3876
Mailing Address - Fax:505-986-9959
Practice Address - Street 1:1422 PASEO DE PERALTA
Practice Address - Street 2:PHARMACY SERVICES UNIT
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-4391
Practice Address - Country:US
Practice Address - Phone:505-988-3876
Practice Address - Fax:505-986-9959
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist