Provider Demographics
NPI:1659095644
Name:LANDERS, DAVID LANIER
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LANIER
Last Name:LANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0669
Mailing Address - Country:US
Mailing Address - Phone:615-289-1665
Mailing Address - Fax:
Practice Address - Street 1:3005 WALNUT CREEK RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6217
Practice Address - Country:US
Practice Address - Phone:615-289-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist