Provider Demographics
NPI:1669992707
Name:VANZANDT, LENNY (RPH)
Entity type:Individual
Prefix:
First Name:LENNY
Middle Name:
Last Name:VANZANDT
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 1:2011 COUNTY HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-9606
Mailing Address - Country:US
Mailing Address - Phone:256-572-0987
Mailing Address - Fax:
Practice Address - Street 1:11697 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-5740
Practice Address - Country:US
Practice Address - Phone:256-878-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist