Provider Demographics
NPI:1841735057
Name:VAN LAHR, JONATHAN G (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
Last Name:VAN LAHR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:GABE
Other - Middle Name:
Other - Last Name:VAN LAHR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14020 E HIGHWAY 60
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-7166
Mailing Address - Country:US
Mailing Address - Phone:270-547-2855
Mailing Address - Fax:270-547-2857
Practice Address - Street 1:14020 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146-7166
Practice Address - Country:US
Practice Address - Phone:270-547-8285
Practice Address - Fax:270-547-2857
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP012958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist