Healthcare Provider Details

I. General information

NPI: 1992600019
Provider Name (Legal Business Name): MAX LANE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MEDICAL CENTER PKWY
MURFREESBORO TN
37129-2245
US

IV. Provider business mailing address

1495 ANTHONY WAY
MOUNT JULIET TN
37122-3558
US

V. Phone/Fax

Practice location:
  • Phone: 615-396-4124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number49951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: