Provider Demographics
NPI:1770347726
Name:DEREMER, LANNY M (PHARMD BCGP)
Entity type:Individual
Prefix:
First Name:LANNY
Middle Name:M
Last Name:DEREMER
Suffix:
Gender:F
Credentials:PHARMD BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13067 CAMINITO MAR VILLA
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3607
Mailing Address - Country:US
Mailing Address - Phone:858-735-9350
Mailing Address - Fax:
Practice Address - Street 1:13067 CAMINITO MAR VILLA
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3607
Practice Address - Country:US
Practice Address - Phone:858-735-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45569183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist