Basic Information
| Provider Information | |||||||||
| NPI: | 1013325679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 576 JEFFERSON AVE | ||||||||
| Address2: | MCDONALD ARMY HEALTH CENTER | ||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573147500 | ||||||||
| FaxNumber: | 7573147854 | ||||||||
| Practice Location | |||||||||
| Address1: | 576 JEFFERSON AVE | ||||||||
| Address2: | MCDONALD ARMY HEALTH CENTER | ||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573147500 | ||||||||
| FaxNumber: | 7573147854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2014 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH235300 | MA | N | Pharmacy Service Providers | Pharmacist | 183500000X | RPH05379 | RI | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | RPH05379 | RI | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | PH235300 | MA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.