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NPI Code Detail

MEDICARE: DR. LANA GORE PHARM.D.

MEDICARE: DR. LANA GORE PHARM.D.
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
1183500000XPharmacistRPH 53750CA

General Provider Information

NPI Number : 1528121720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANA GORE PHARM.D.
Provider Business Mailing Address
First Line : 848 7TH ST APT 6
Second Line :
City : SANTA MONICA
State : CA
Zip : 90403-1443
Country : US
Telephone Number : 310-804-3005
Fax Number :
Provider Business Practice Location Address
First Line : 5971 VENICE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-1713
Country : US
Telephone Number : 323-857-3689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ DR. LANA GORE PHARM.D.” Practice Location

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