Healthcare Provider Details

I. General information

NPI: 1225627243
Provider Name (Legal Business Name): CRYSTAL MARIE LANE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 FM 1960 RD E
HUMBLE TX
77346-3128
US

IV. Provider business mailing address

7405 FM 1960 RD E
HUMBLE TX
77346-3128
US

V. Phone/Fax

Practice location:
  • Phone: 281-812-4729
  • Fax:
Mailing address:
  • Phone: 281-812-4729
  • Fax: 281-812-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: