Healthcare Provider Details

I. General information

NPI: 1538725528
Provider Name (Legal Business Name): FANI LANE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 9TH AVE S
ST PETERSBURG FL
33701-5210
US

IV. Provider business mailing address

550 9TH AVE S
ST PETERSBURG FL
33701-5210
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8212
  • Fax: 727-767-8243
Mailing address:
  • Phone: 727-767-8212
  • Fax: 727-767-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPS38690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: