Provider Demographics
NPI:1831610831
Name:LANE, FRANCES EVANGELINE
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:EVANGELINE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1760
Mailing Address - Country:US
Mailing Address - Phone:256-221-2811
Mailing Address - Fax:
Practice Address - Street 1:42466 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7052
Practice Address - Country:US
Practice Address - Phone:205-486-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL15463OtherBOARD OF PHARMACY