Provider Demographics
NPI:1891999892
Name:LANE, JOHN L (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:LANE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1318
Mailing Address - Country:US
Mailing Address - Phone:605-745-5127
Mailing Address - Fax:605-745-4617
Practice Address - Street 1:2500 MINNEKAHTA AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1129
Practice Address - Country:US
Practice Address - Phone:605-745-5127
Practice Address - Fax:605-745-4617
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6120183500000X
MT3716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist