Provider Demographics
NPI:1548289077
Name:LANE, CARRIE A (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1504
Mailing Address - Country:US
Mailing Address - Phone:785-447-0527
Mailing Address - Fax:
Practice Address - Street 1:708 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1529
Practice Address - Country:US
Practice Address - Phone:785-632-3032
Practice Address - Fax:785-632-5943
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist