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General NPI Number Information
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NPI Number | 1538725528
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Entity Type | Individual
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Provider Name | FANI LANE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 550 9TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-5210
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Country | US
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Telephone | 727-767-8212
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Fax | 727-767-8243
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Provider Business Mailing Address
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Address Line | 550 9TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-5210
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Country | US
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Telephone | 727-767-8212
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Fax | 727-767-8243
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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 | 1835P0200X
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Taxonomy Name | Pediatric Pharmacist
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License Number | PS38690
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License Number State | FL
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