Individual provider Active NPI

Susan M Lang, PHARMACIST

  • Pharmacist
  • Peabody, MA
National Provider Identifier
1962006916
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH18403 Issued in MA
Practice address
100 Brooksby Village Dr
Peabody, MA 01960-1438
Phone
(978) 326-2350
Fax
(978) 536-6937
NPI assigned
Nov 30, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH18403 MA Primary

Addresses

Primary practice location

100 Brooksby Village Dr
Peabody, MA 01960-1438

Mailing address

47 Oak Ridge Cir
Lynn, MA 01904-1527
Phone (781) 690-3547

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Peabody Direct Main Street Pharmacy, LLC

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

State licenses

LicenseStateTypeSpecialty
PH18403MAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1962006916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 OAK RIDGE CIR",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019041527",
            "telephone_number": "781-690-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROOKSBY VILLAGE DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601438",
            "telephone_number": "978-326-2350",
            "fax_number": "978-536-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANG",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH18403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Peabody",
            "affiliation": "Y",
            "endpointDescription": "100 Brooksby Village Drive",
            "affiliationName": "Main Street Pharmacy, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Brooksby Village Dr",
            "city": "Peabody",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019601438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.