Provider Demographics
NPI:1073842670
Name:CARPENTER, LANCE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3033
Mailing Address - Country:US
Mailing Address - Phone:970-564-9165
Mailing Address - Fax:
Practice Address - Street 1:1671 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3033
Practice Address - Country:US
Practice Address - Phone:970-564-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010442183500000X
CO17100183500000X
ORRPH-0010778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist