Healthcare Provider Details

I. General information

NPI: 1912018003
Provider Name (Legal Business Name): LANE DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WEST ROBB AVENUE
LIMA OH
45801-2745
US

IV. Provider business mailing address

200 NEWBERRY COMMONS
ETTERS PA
17319-9363
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-5846
  • Fax:
Mailing address:
  • Phone: 717-761-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0732247
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 2
Identifier3651583
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER

VIII. Authorized Official

Name: JENNIFER M ZOREK
Title or Position: SR MANAGER THIRD PARTY ENROLLMENTS
Credential:
Phone: 717-975-5937