Individual
MR. DONALD KEITH LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
112 S DOOLY ST, MONTEZUMA, GA 31063-1604
(478) 472-7561
(478) 472-5887
Mailing address
PO BOX 250, 112 SOUTH DOOLY STREET, MONTEZUMA, GA 31063-0250
(478) 472-7561
(478) 472-5887
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH013836
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00927649A
—
GA
01
—
1112527
NCPDP
GA
01
—
RPH013836
PHARMACIST LICENSE
GA
Enumeration date
02/06/2006
Last updated
03/07/2023
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