Provider Demographics
NPI:1619665726
Name:ALLAS, LANA (RPH)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:ALLAS
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 1:811 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3209
Mailing Address - Country:US
Mailing Address - Phone:314-315-1993
Mailing Address - Fax:
Practice Address - Street 1:12345 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2505
Practice Address - Country:US
Practice Address - Phone:636-770-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023012054202C00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner