Provider Demographics
NPI:1821053067
Name:MOHL, LANCE WADE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:WADE
Last Name:MOHL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 25 1/2 AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-0781
Mailing Address - Country:US
Mailing Address - Phone:701-839-9353
Mailing Address - Fax:701-839-5529
Practice Address - Street 1:400 BURDICK EXPY E
Practice Address - Street 2:KEYCARE PHARMACY
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-7900
Practice Address - Fax:701-857-7834
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist