Provider Demographics
NPI:1922310648
Name:LANE, KINDLELYN SHAVAWN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:KINDLELYN
Middle Name:SHAVAWN
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18202 STILLWATER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4449
Mailing Address - Country:US
Mailing Address - Phone:832-519-7282
Mailing Address - Fax:
Practice Address - Street 1:7440 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3129
Practice Address - Country:US
Practice Address - Phone:281-852-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist