Provider Demographics
NPI:1053138610
Name:CHERAMIE, LANE MYLES (RPH)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:MYLES
Last Name:CHERAMIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3831
Mailing Address - Country:US
Mailing Address - Phone:985-258-7335
Mailing Address - Fax:
Practice Address - Street 1:136 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-9072
Practice Address - Country:US
Practice Address - Phone:985-258-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD096863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy