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NPI Code Detail

MEDICARE: DR. ALEXIS NICOLE LANE PHARM.D.

MEDICARE: DR. ALEXIS NICOLE LANE PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist26028218AIN

General Provider Information

NPI Number : 1912569385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXIS NICOLE LANE PHARM.D.
Provider Business Mailing Address
First Line : 8648 TOZER CT APT 4
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4809
Country : US
Telephone Number : 260-446-6573
Fax Number :
Provider Business Practice Location Address
First Line : 2121 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5100
Country : US
Telephone Number : 260-426-5431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2019
Last Update Date : 05/07/2026

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