Provider Demographics
NPI:1003182825
Name:LANE, KEIRA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KEIRA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 FLETCHER PKWY
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3231
Mailing Address - Country:US
Mailing Address - Phone:619-667-9626
Mailing Address - Fax:
Practice Address - Street 1:8920 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3231
Practice Address - Country:US
Practice Address - Phone:619-667-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53457183500000X
NV15353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist