Provider Demographics
NPI:1538725528
Name:LANE, FANI (PHARMD)
Entity type:Individual
Prefix:
First Name:FANI
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5210
Mailing Address - Country:US
Mailing Address - Phone:727-767-8212
Mailing Address - Fax:727-767-8243
Practice Address - Street 1:550 9TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-5210
Practice Address - Country:US
Practice Address - Phone:727-767-8212
Practice Address - Fax:727-767-8243
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS386901835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics