Provider Demographics
NPI:1487766440
Name:LANE, ELIA E (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELIA
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6319
Mailing Address - Country:US
Mailing Address - Phone:850-438-9792
Mailing Address - Fax:
Practice Address - Street 1:4751 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2607
Practice Address - Country:US
Practice Address - Phone:850-479-9267
Practice Address - Fax:850-479-9216
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist