Provider Demographics
NPI:1346527710
Name:LANASA, MARK ANTHONY JR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:LANASA
Suffix:JR
Gender:M
Credentials:CPHT
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Mailing Address - Street 1:200 HAWTHORNE LN
Mailing Address - Street 2:3RD FLOOR PHARMACY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2515
Mailing Address - Country:US
Mailing Address - Phone:704-384-9480
Mailing Address - Fax:704-316-4496
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:3RD FLOOR PHARMACY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-9480
Practice Address - Fax:704-316-4496
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2014-10-16
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Provider Licenses
StateLicense IDTaxonomies
NC19485183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician