Provider Demographics
NPI:1508151242
Name:LANASA, TERRY SUE (PHARM D)
Entity Type:Individual
Prefix:
First Name:TERRY SUE
Middle Name:
Last Name:LANASA
Suffix:
Gender:F
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 1:2908 LOBLOLLY CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7833
Mailing Address - Country:US
Mailing Address - Phone:850-608-6249
Mailing Address - Fax:
Practice Address - Street 1:853 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2709
Practice Address - Country:US
Practice Address - Phone:850-654-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist