Provider Demographics
NPI:1487204590
Name:LANTAFF, WENDY MICHELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELE
Last Name:LANTAFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 RUCKLE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3970
Mailing Address - Country:US
Mailing Address - Phone:770-310-0451
Mailing Address - Fax:
Practice Address - Street 1:10735 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2838
Practice Address - Country:US
Practice Address - Phone:317-823-1819
Practice Address - Fax:317-823-1855
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026241A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care