Provider Demographics
NPI:1609121227
Name:LANG, ANITA JO (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:JO
Last Name:LANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BRIANS WAY
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-4296
Mailing Address - Country:US
Mailing Address - Phone:707-673-6539
Mailing Address - Fax:
Practice Address - Street 1:2401 WATERMAN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1800
Practice Address - Country:US
Practice Address - Phone:707-427-5642
Practice Address - Fax:707-427-5645
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist