Individual
KIMBERLY KAY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 SADDLETREE RD, SHAVANO PARK, TX 78231-1543
(210) 286-3554
Mailing address
200 SADDLETREE RD, SHAVANO PARK, TX 78231-1543
(210) 286-3554
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
29311
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29311
BOARD OF PHARMACY
TX
Enumeration date
12/30/2019
Last updated
12/30/2019
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