Basic Information
Provider Information
NPI: 1417042383
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANIER
FirstName: RANDI
MiddleName: RANAE
NamePrefix: MS.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 FOOTHILL DR
Address2:  
City: POTEAU
State: OK
PostalCode: 74953
CountryCode: US
TelephoneNumber: 9186474150
FaxNumber: 9185677037
Practice Location
Address1: CHOCTAW NATION HEALTH CARE CENTER
Address2: ONE CHOCTAW WAY
City: TALIHINA
State: OK
PostalCode: 74571
CountryCode: US
TelephoneNumber: 9185677000
FaxNumber: 9185677037
Other Information
ProviderEnumerationDate: 10/04/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X13432OKY Pharmacy Service ProvidersPharmacist 

No ID Information.


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