Provider Demographics
NPI:1760008130
Name:LANE, HANNAH N (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:N
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DELL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5813
Mailing Address - Country:US
Mailing Address - Phone:618-920-9217
Mailing Address - Fax:
Practice Address - Street 1:120 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260-1156
Practice Address - Country:US
Practice Address - Phone:618-476-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist