Provider Demographics
NPI:1134530777
Name:JANTZ, ALLEN E (RPH)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:E
Last Name:JANTZ
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 1:3245 DEODAR ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3968
Mailing Address - Country:US
Mailing Address - Phone:916-485-7580
Mailing Address - Fax:
Practice Address - Street 1:5159 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5750
Practice Address - Country:US
Practice Address - Phone:916-483-0419
Practice Address - Fax:916-483-7855
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist