Provider Demographics
NPI:1699024729
Name:LAUTZENHEISER, DANA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:LAUTZENHEISER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1805 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2801
Practice Address - Country:US
Practice Address - Phone:937-615-7020
Practice Address - Fax:937-615-7055
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist