Provider Demographics
NPI:1790027159
Name:VILLALUZ, LANCELOT KENG (R PH)
Entity Type:Individual
Prefix:MR
First Name:LANCELOT
Middle Name:KENG
Last Name:VILLALUZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4635
Mailing Address - Country:US
Mailing Address - Phone:765-287-8533
Mailing Address - Fax:
Practice Address - Street 1:2720 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4635
Practice Address - Country:US
Practice Address - Phone:765-287-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021340A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist