MEDICARE: SAGE-LANZ INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	0201002810	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4824252	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1255323234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE-LANZ INC

Provider Business Mailing Address
First Line	:	5015 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-3003
Country	:	US
Telephone Number	:	540-869-1660
Fax Number	:	540-869-1463

Provider Business Practice Location Address
First Line	:	5015 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-3003
Country	:	US
Telephone Number	:	540-869-1660
Fax Number	:	540-869-1463

Authorized Official
Title or Position	:	OWNER PIC
Name	:	KEITH LANTZ
Credential	:
Telephone Number	:	540-869-1660

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/19/2012

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Directions to “SAGE-LANZ INC ” Practice Location

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