Provider Demographics
NPI:1447473012
Name:DANCE, BRENT LANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LANE
Last Name:DANCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S 25 MILE AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-4801
Mailing Address - Country:US
Mailing Address - Phone:806-335-0729
Mailing Address - Fax:806-372-6550
Practice Address - Street 1:809 S 25 MILE AVE
Practice Address - Street 2:HEREFORD PHARMACY
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4801
Practice Address - Country:US
Practice Address - Phone:806-364-3400
Practice Address - Fax:806-364-3405
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist