Provider Demographics
NPI:1689957821
Name:LANTUM, ADELINE W (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:W
Last Name:LANTUM
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 1:50 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1325
Mailing Address - Country:US
Mailing Address - Phone:978-640-0002
Mailing Address - Fax:
Practice Address - Street 1:800 RIVER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-3612
Practice Address - Country:US
Practice Address - Phone:978-521-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist