Provider Demographics
NPI:1659658912
Name:KEITH, LANA S
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:S
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2452
Mailing Address - Country:US
Mailing Address - Phone:719-473-7300
Mailing Address - Fax:719-473-0614
Practice Address - Street 1:1855 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2452
Practice Address - Country:US
Practice Address - Phone:719-473-7300
Practice Address - Fax:719-473-0614
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist