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General NPI Number Information
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NPI Number | 1992418081
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Entity Type | Individual
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Provider Name | STEPHANIE NICHOLE LANE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 1987 W 4TH ST STE 200
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City | ONTARIO
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State | OH
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Zip | 44906-1708
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Country | US
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Telephone | 419-756-2559
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Fax |
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Provider Business Mailing Address
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Address Line | 4054 STATE ROUTE 13
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City | BELLVILLE
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State | OH
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Zip | 44813-9006
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Country | US
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Telephone | 141-996-1259
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Fax |
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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 | 03230071
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License Number State | OH
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