=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922215219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL CHRISTOPHER LANE PHARMD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 05/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N MAIN STREET CB 3087
-----------------------------------------------------
City | WINGATE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-233-8672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5416 MACROOM CT
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-0600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-608-4504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03-2-26564
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16495
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------