Provider Demographics
NPI:1609191063
Name:THOMAS-LANE, MARIAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:THOMAS-LANE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MOSHOLU AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2214
Mailing Address - Country:US
Mailing Address - Phone:646-554-0678
Mailing Address - Fax:
Practice Address - Street 1:2702 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5323
Practice Address - Country:US
Practice Address - Phone:646-554-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist