Provider Demographics
NPI:1871128249
Name:LANGE, NICOLE BRUER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BRUER
Last Name:LANGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-0203
Mailing Address - Country:US
Mailing Address - Phone:903-868-1565
Mailing Address - Fax:
Practice Address - Street 1:1820 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-0203
Practice Address - Country:US
Practice Address - Phone:903-868-1565
Practice Address - Fax:903-868-9657
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX494291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist