Provider Demographics
NPI:1225341480
Name:LANE, LATOYA LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:LYNNE
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 1:10228 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8087
Mailing Address - Country:US
Mailing Address - Phone:281-504-0285
Mailing Address - Fax:281-504-0287
Practice Address - Street 1:10228 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8087
Practice Address - Country:US
Practice Address - Phone:281-504-0285
Practice Address - Fax:281-504-0287
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist