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General NPI Number Information
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NPI Number | 1508838327
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Entity Type | Individual
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Provider Name | DONALD KEITH LANE RPH
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 112 S DOOLY ST
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City | MONTEZUMA
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State | GA
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Zip | 31063-1604
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Country | US
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Telephone | 478-472-7561
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Fax | 478-472-5887
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Provider Business Mailing Address
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Address Line | PO BOX 250 112 SOUTH DOOLY STREET
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City | MONTEZUMA
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State | GA
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Zip | 31063-0250
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Country | US
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Telephone | 478-472-7561
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Fax | 478-472-5887
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH013836
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License Number State | GA
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