Provider Demographics
NPI:1982986311
Name:LANG, JASON ROBERT (PHARM D)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:LANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 SOLAR DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1941
Mailing Address - Country:US
Mailing Address - Phone:801-870-8073
Mailing Address - Fax:
Practice Address - Street 1:515 W 500 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8101
Practice Address - Country:US
Practice Address - Phone:801-294-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6158191-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist