Provider Demographics
NPI:1588989578
Name:LANE, BRANDY (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
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 1:403 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3142
Mailing Address - Country:US
Mailing Address - Phone:870-972-9125
Mailing Address - Fax:870-972-1624
Practice Address - Street 1:403 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-972-9125
Practice Address - Fax:870-972-1624
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist