Provider Demographics
NPI:1114245255
Name:WORTHINGTON, EDWARD LANE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LANE
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 LOS OSOS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3204
Mailing Address - Country:US
Mailing Address - Phone:805-528-5779
Mailing Address - Fax:805-528-8617
Practice Address - Street 1:1110 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3204
Practice Address - Country:US
Practice Address - Phone:805-528-5779
Practice Address - Fax:805-528-8617
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66632183500000X
OR12886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist