Provider Demographics
NPI:1952633877
Name:LANTZ, STACEY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:LANTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ERICSSON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-6501
Mailing Address - Country:US
Mailing Address - Phone:724-772-6000
Mailing Address - Fax:901-473-5057
Practice Address - Street 1:3000 ERICSSON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-6501
Practice Address - Country:US
Practice Address - Phone:724-772-6000
Practice Address - Fax:901-473-5057
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043037R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist