Lane Avenue Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH23097 Issued in FL

Legal business name

LANE AVENUE PHARMACY INC

Doing business as

LANE AVENUE PHARMACY

Practice address

1233 Lane Ave S
Ste 9
Jacksonville, FL 32205-6284

Phone

(904) 693-6633

Fax

(904) 693-6684

NPI assigned

Jan 8, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Felix Obasuyi, RPH

Title

Owner / Pharmacist

Phone

(904) 693-6633

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• LANE AVENUE PHARMACY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276473600000",
    "number": "1427233584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 WATERMILL DR",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320731621",
            "telephone_number": "904-693-6633",
            "fax_number": "904-693-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 LANE AVE S",
            "address_2": "STE 9",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056284",
            "telephone_number": "904-693-6633",
            "fax_number": "904-693-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANE AVENUE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2010-06-14",
        "status": "A",
        "authorized_official_last_name": "OBASUYI",
        "authorized_official_first_name": "FELIX",
        "authorized_official_title_or_position": "OWNER / PHARMACIST",
        "authorized_official_telephone_number": "904-693-6633",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH23097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032420500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1031412",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LANE AVENUE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolyn Landolfo, MD
• Kevin Landolfo, MD
• Cecelia Ann Landry, LCSW
• Patricia A. Landry, A.R.N.P.
• Lisa Landsowne
• Adrian K Lane, PA
• Alyssa Dugger Lane, BCABA
• Amy E Lane
• Ashley Elizabeth Lane
• Brenda Lane

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.