Healthcare Provider Details

I. General information

NPI: 1336928928
Provider Name (Legal Business Name): LANZ GABRIEL ZAPANTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 LEBANON PIKE
HERMITAGE TN
37076-1475
US

IV. Provider business mailing address

418 ADDIE DR
SMYRNA TN
37167-4125
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-4864
  • Fax:
Mailing address:
  • Phone: 615-738-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number47301
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: