Provider Demographics
NPI:1578849683
Name:VAN LANCKER, KRISTA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAY
Last Name:VAN LANCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:KAY
Other - Last Name:KREBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2414 MESA CREST GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1816
Mailing Address - Country:US
Mailing Address - Phone:719-290-2458
Mailing Address - Fax:719-381-4453
Practice Address - Street 1:3159 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2040
Practice Address - Country:US
Practice Address - Phone:719-475-9030
Practice Address - Fax:719-381-4453
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist