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Individual

MR. GAVIN CHARLES LANGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARMACY TECHNICIAN

Contact information

Practice address
6701 HARFORD RD, PARKVILLE, MD 21234-7721
(410) 254-2055
Mailing address
6701 HARFORD RD, PARKVILLE, MD 21234-7787
(410) 254-2055

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
T27627
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MD10272062356
LICENSE
MD
Enumeration date
01/30/2023
Last updated
02/01/2023
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