Healthcare Provider Details

I. General information

NPI: 1467444760
Provider Name (Legal Business Name): MARK ALTON LAND PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST.
PANHANDLE TX
79068
US

IV. Provider business mailing address

1617 PECAN ST. PO BOX 1654
PANHANDLE TX
79068
US

V. Phone/Fax

Practice location:
  • Phone: 806-537-3034
  • Fax: 806-537-5461
Mailing address:
  • Phone: 806-537-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40016
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: