Provider Demographics
NPI:1518346766
Name:LANE, SHAKA (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:SHAKA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:SHAKA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:1507 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-8231
Mailing Address - Country:US
Mailing Address - Phone:254-833-0256
Mailing Address - Fax:
Practice Address - Street 1:1507 RICHARD DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-8231
Practice Address - Country:US
Practice Address - Phone:254-833-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197293183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician