Provider Demographics
NPI:1215141031
Name:LASK, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:LASK
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:PO BOX 51297
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-0297
Mailing Address - Country:US
Mailing Address - Phone:215-000-0000
Mailing Address - Fax:
Practice Address - Street 1:6912 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-2410
Practice Address - Country:US
Practice Address - Phone:215-949-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035759R183500000X
NJ28RI01813600183500000X
AZ13979183500000X
NV15312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist