Provider Demographics
NPI:1942975974
Name:LANTZ, KARLEY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARLEY
Middle Name:J
Last Name:LANTZ
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 1:244 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-7122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ND
Practice Address - Zip Code:58853-9998
Practice Address - Country:US
Practice Address - Phone:701-572-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist