Provider Demographics
NPI:1528583010
Name:FAIRES, LANAE KRISTEN (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:LANAE
Middle Name:KRISTEN
Last Name:FAIRES
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1238
Mailing Address - Country:US
Mailing Address - Phone:520-975-3531
Mailing Address - Fax:
Practice Address - Street 1:2622 W CENTRAL AVE STE 302
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4973
Practice Address - Country:US
Practice Address - Phone:316-265-3300
Practice Address - Fax:316-265-3300
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist