| NPI | 1093024721 |
|---|---|
| Former Name | KELLY L LANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036260) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301005276) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2015-12-16 |