MEDICARE: JOHN L LANE RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6120	SD
2	183500000X	Pharmacist	3716	MT

General Provider Information

NPI Number	:	1891999892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L LANE RPH.

Provider Business Mailing Address
First Line	:	401 N 17TH ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1318
Country	:	US
Telephone Number	:	605-745-5127
Fax Number	:	605-745-4617

Provider Business Practice Location Address
First Line	:	2500 MINNEKAHTA AVE
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1129
Country	:	US
Telephone Number	:	605-745-5127
Fax Number	:	605-745-4617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/21/2022

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