Provider Demographics
NPI:1912493602
Name:LANCE, ALEXIS MARIAH (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIAH
Last Name:LANCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9358
Mailing Address - Country:US
Mailing Address - Phone:517-630-1488
Mailing Address - Fax:
Practice Address - Street 1:408 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-2153
Practice Address - Country:US
Practice Address - Phone:269-319-4010
Practice Address - Fax:269-659-5265
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020425041835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy