Provider Demographics
NPI:1619570447
Name:LANE, KAYLA RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:LANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81032 E SPRING CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:NE
Mailing Address - Zip Code:68842-4299
Mailing Address - Country:US
Mailing Address - Phone:308-202-0264
Mailing Address - Fax:
Practice Address - Street 1:125 S 16TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1464
Practice Address - Country:US
Practice Address - Phone:308-202-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist