Provider Demographics
NPI:1831471754
Name:LANE, LORENEA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LORENEA
Middle Name:MARIE
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 1:686 TAPPAN ST
Mailing Address - Street 2:APT#1038
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6039
Mailing Address - Country:US
Mailing Address - Phone:317-777-2638
Mailing Address - Fax:
Practice Address - Street 1:7235 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3565
Practice Address - Country:US
Practice Address - Phone:317-487-9250
Practice Address - Fax:317-241-3796
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023447A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26023447AOtherPHARMACIST LICENSE NUMBER