Healthcare Provider Details

I. General information

NPI: 1376254656
Provider Name (Legal Business Name): JANE KELLY LAKRITZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37160 47TH ST E
PALMDALE CA
93552-4450
US

IV. Provider business mailing address

37160 47TH ST E
PALMDALE CA
93552-4450
US

V. Phone/Fax

Practice location:
  • Phone: 661-903-0168
  • Fax:
Mailing address:
  • Phone: 661-903-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: