Provider Demographics
NPI:1295011260
Name:SERR, LANE A, (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LANE
Middle Name:A,
Last Name:SERR
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 1:188 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2140
Mailing Address - Country:US
Mailing Address - Phone:435-228-1003
Mailing Address - Fax:435-228-1006
Practice Address - Street 1:188 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2140
Practice Address - Country:US
Practice Address - Phone:435-228-1003
Practice Address - Fax:435-228-1006
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292419-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist