Healthcare Provider Details

I. General information

NPI: 1255323234
Provider Name (Legal Business Name): SAGE-LANZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 MAIN ST
STEPHENS CITY VA
22655-3003
US

IV. Provider business mailing address

5015 MAIN ST
STEPHENS CITY VA
22655-3003
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-1660
  • Fax: 540-869-1463
Mailing address:
  • Phone: 540-869-1660
  • Fax: 540-869-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201002810
License Number StateVA

VIII. Authorized Official

Name: KEITH LANTZ
Title or Position: OWNER PIC
Credential:
Phone: 540-869-1660