Provider Demographics
NPI:1295854305
Name:MCLANE, KATHLEEN LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LYNN
Last Name:MCLANE
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 1:415 W LAS CRUCES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2513
Mailing Address - Country:US
Mailing Address - Phone:505-523-6317
Mailing Address - Fax:
Practice Address - Street 1:415 W LAS CRUCES AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2513
Practice Address - Country:US
Practice Address - Phone:505-523-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist