Healthcare Provider Details

I. General information

NPI: 1164335154
Provider Name (Legal Business Name): LANE BROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 ELM RD NE
WARREN OH
44483-2614
US

IV. Provider business mailing address

15765 MAIN MARKET RD
BURTON OH
44021-9621
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-4622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: