Provider Demographics
NPI:1942584586
Name:HIGHTOWER, LANET E
Entity type:Individual
Prefix:MRS
First Name:LANET
Middle Name:E
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20321 SUSAN LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5682
Mailing Address - Country:US
Mailing Address - Phone:703-726-8647
Mailing Address - Fax:
Practice Address - Street 1:20321 SUSAN LESLIE DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5682
Practice Address - Country:US
Practice Address - Phone:703-726-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44803183500000X
VA0202209776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA361924025OtherTAXONOMY