Provider Demographics
NPI:1346748712
Name:LANTRIP, JAN MATHERNE
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MATHERNE
Last Name:LANTRIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-0328
Mailing Address - Country:US
Mailing Address - Phone:225-567-1921
Mailing Address - Fax:225-567-1931
Practice Address - Street 1:29148 SOUTH MONTPELIER AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-0328
Practice Address - Country:US
Practice Address - Phone:225-567-1921
Practice Address - Fax:225-567-1931
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.0117831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist