Provider Demographics
NPI:1184716557
Name:LANGSTON, BERNARD J (RPH)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:J
Last Name:LANGSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1531 MONUMENT RD
Practice Address - Street 2:WIN DIXIE R 0054
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:904-998-8999
Practice Address - Fax:904-998-0099
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008440183500000X
FLPS009723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist