NPIMap

Individual provider Active NPI

Jeff Russell Langham, RPH

  • Pharmacist
  • Mishawaka, IN
National Provider Identifier
1770129843
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
26091666A Issued in IN
Practice address
906 S Merrifield Ave
Mishawaka, IN 46544-2807
Phone
(574) 256-7522
Fax
(574) 256-7524
NPI assigned
Nov 22, 2019
Last updated
Nov 22, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 26091666A IN Primary

Addresses

Primary practice location

906 S Merrifield Ave
Mishawaka, IN 46544-2807

Mailing address

906 S Merrifield Ave
Mishawaka, IN 46544-2807
Phone (574) 256-7522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
26091666AINMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I PastSince Nov 24, 2019 Accepting new patients
Kroger Limited Partnership I PastSince Nov 24, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1770129843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 S MERRIFIELD AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442807",
            "telephone_number": "574-256-7522",
            "fax_number": "574-256-7524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 S MERRIFIELD AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442807",
            "telephone_number": "574-256-7522",
            "fax_number": "574-256-7524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGHAM",
        "first_name": "JEFF",
        "middle_name": "RUSSELL",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-22",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26091666A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.