Healthcare Provider Details

I. General information

NPI: 1164712303
Provider Name (Legal Business Name): LANA SHANER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 PERKIOMEN AVE
READING PA
19606-3296
US

IV. Provider business mailing address

1910 WEISSTOWN RD
BOYERTOWN PA
19512-7810
US

V. Phone/Fax

Practice location:
  • Phone: 610-779-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443547
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: