Provider Demographics
NPI:1548245681
Name:LAND, LENNON LOWELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:LENNON
Middle Name:LOWELL
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 1:1749 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5729
Mailing Address - Country:US
Mailing Address - Phone:850-479-3496
Mailing Address - Fax:850-466-4634
Practice Address - Street 1:1749 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5729
Practice Address - Country:US
Practice Address - Phone:850-479-3496
Practice Address - Fax:850-466-4634
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225394OtherNABP PERSONAL REGISTRATION
FL5736218OtherNABP PRACTICE LOCATION