Provider Demographics
NPI:1225338890
Name:GANTER, MONICA LENTZ (RPH)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LENTZ
Last Name:GANTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14525 IVY DALE COURT.
Mailing Address - Street 2:
Mailing Address - City:SWAN POINT
Mailing Address - State:MD
Mailing Address - Zip Code:20645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 SHINING WILLOW WAY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4224
Practice Address - Country:US
Practice Address - Phone:301-392-1878
Practice Address - Fax:301-392-1878
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist