Provider Demographics
NPI:1801057880
Name:DE LANGE, SUNETTE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SUNETTE
Middle Name:
Last Name:DE LANGE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5123
Mailing Address - Country:US
Mailing Address - Phone:805-934-4002
Mailing Address - Fax:805-934-4782
Practice Address - Street 1:1120 E CLARK AVE
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-5123
Practice Address - Country:US
Practice Address - Phone:805-934-4002
Practice Address - Fax:805-934-4782
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist