Provider Demographics
NPI:1336873900
Name:HART, AGES LANAR
Entity Type:Individual
Prefix:MR
First Name:AGES
Middle Name:LANAR
Last Name:HART
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:WALGREENS
Mailing Address - Street 2:5710 YOUNG PINE RD
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:31825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS
Practice Address - Street 2:5710 YOUNG PINE RD
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:31825
Practice Address - Country:US
Practice Address - Phone:689-837-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist