Provider Demographics
NPI:1447560164
Name:JAHN, LEMONT WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEMONT
Middle Name:WILLIAM
Last Name:JAHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 S CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072
Mailing Address - Country:US
Mailing Address - Phone:701-845-1421
Mailing Address - Fax:701-845-4167
Practice Address - Street 1:148 S CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072
Practice Address - Country:US
Practice Address - Phone:701-845-1421
Practice Address - Fax:701-845-4167
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3396OtherND PHARMACY LICENSE NUMBER