Provider Demographics
NPI:1275881294
Name:LANE, JILL LINETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LINETTE
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 1:702 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1204
Mailing Address - Country:US
Mailing Address - Phone:864-879-2146
Mailing Address - Fax:864-801-3963
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1204
Practice Address - Country:US
Practice Address - Phone:864-879-2146
Practice Address - Fax:864-801-3963
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist