Provider Demographics
NPI:1700480548
Name:KRANTZ, JEFFREY LANE (BSPHARM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LANE
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1648
Mailing Address - Country:US
Mailing Address - Phone:270-753-0287
Mailing Address - Fax:270-753-0282
Practice Address - Street 1:809 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1648
Practice Address - Country:US
Practice Address - Phone:270-753-0287
Practice Address - Fax:270-753-0282
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist