Provider Demographics
NPI:1992418081
Name:LANE, STEPHANIE NICHOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:NICHOLE
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4054 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9006
Mailing Address - Country:US
Mailing Address - Phone:141-996-1259
Mailing Address - Fax:
Practice Address - Street 1:1987 W 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1708
Practice Address - Country:US
Practice Address - Phone:419-756-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist