Provider Demographics
NPI:1629325816
Name:TAKACS, LANCE G (PHARM,D,)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:G
Last Name:TAKACS
Suffix:
Gender:M
Credentials:PHARM,D,
Other - Prefix:
Other - First Name:LASZLO
Other - Middle Name:
Other - Last Name:TAKACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7300 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2305
Mailing Address - Country:US
Mailing Address - Phone:520-575-0662
Mailing Address - Fax:
Practice Address - Street 1:7300 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2305
Practice Address - Country:US
Practice Address - Phone:520-575-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016500183500000X
FLPS38208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist