Provider Demographics
NPI:1467444760
Name:LAND, MARK ALTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALTON
Last Name:LAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 PECAN ST.
Mailing Address - Street 2:PO BOX 1654
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068
Mailing Address - Country:US
Mailing Address - Phone:806-537-5754
Mailing Address - Fax:
Practice Address - Street 1:201 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PANHANDLE
Practice Address - State:TX
Practice Address - Zip Code:79068
Practice Address - Country:US
Practice Address - Phone:806-537-3034
Practice Address - Fax:806-537-5461
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist