Provider Demographics
NPI:1811003171
Name:LANHAM, MARY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY LYNN
Middle Name:
Last Name:LANHAM
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 1:29E QUEEN MARY CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2594
Mailing Address - Country:US
Mailing Address - Phone:410-643-5078
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DRIVE
Practice Address - Street 2:TATE BUILDING, LOWER LEVEL
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-787-4483
Practice Address - Fax:410-595-1974
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist