Provider Demographics
NPI:1104282557
Name:LANG, GARY EDWARD
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:EDWARD
Last Name:LANG
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 1:4389 BEAUFORT RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28533
Mailing Address - Country:US
Mailing Address - Phone:252-466-0119
Mailing Address - Fax:
Practice Address - Street 1:4389 BEAUFORT RD
Practice Address - Street 2:
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC179331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist