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General NPI Number Information
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NPI Number | 1417058850
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Entity Type | Individual
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Provider Name | JUDY CAROLINE LANCE PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2747 FOURTH ST
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City | BRUNSWICK
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State | GA
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Zip | 31520
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Country | US
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Telephone | 912-279-3353
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Fax | 912-554-8397
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Provider Business Mailing Address
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Address Line | 309 SANDCASTLE LANE
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522
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Country | US
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Telephone | 912-634-9329
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Fax | 912-634-9553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03108132
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 017904
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License Number State | GA
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