Provider Demographics
NPI:1447528617
Name:BACH, DANG LAN
Entity type:Individual
Prefix:MR
First Name:DANG LAN
Middle Name:
Last Name:BACH
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:PO BOX 825631
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-5631
Mailing Address - Country:US
Mailing Address - Phone:954-253-2335
Mailing Address - Fax:
Practice Address - Street 1:6700 DYKES RD
Practice Address - Street 2:
Practice Address - City:SW RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-4665
Practice Address - Country:US
Practice Address - Phone:954-434-9956
Practice Address - Fax:954-434-9962
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 38825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist