Provider Demographics
NPI:1497386643
Name:LANE, MELINDA BAXTER (RPH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:BAXTER
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 1:1215 S KIHEI RD
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5220
Mailing Address - Country:US
Mailing Address - Phone:808-879-2033
Mailing Address - Fax:
Practice Address - Street 1:1215 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5220
Practice Address - Country:US
Practice Address - Phone:808-879-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist