Provider Demographics
NPI:1346334752
Name:LANES PHARMACY INC
Entity Type:Organization
Organization Name:LANES PHARMACY INC
Other - Org Name:LANES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-589-3011
Mailing Address - Street 1:1301 HORRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-4531
Mailing Address - Country:US
Mailing Address - Phone:337-589-3011
Mailing Address - Fax:337-589-3579
Practice Address - Street 1:1301 HORRIDGE ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4531
Practice Address - Country:US
Practice Address - Phone:337-589-3011
Practice Address - Fax:337-589-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.004131-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1266671Medicaid
1911569OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1264130001Medicare NSC