Provider Demographics
NPI:1912423716
Name:MILES, JASON LANG
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LANG
Last Name:MILES
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 1:1687 ERRINGER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6509
Mailing Address - Country:US
Mailing Address - Phone:805-527-9600
Mailing Address - Fax:805-527-2095
Practice Address - Street 1:1687 ERRINGER RD STE 101
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6509
Practice Address - Country:US
Practice Address - Phone:805-527-9600
Practice Address - Fax:805-527-2095
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist