Provider Demographics
NPI:1740884535
Name:MONTAG, LANORA (PHARM D)
Entity type:Individual
Prefix:
First Name:LANORA
Middle Name:
Last Name:MONTAG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LANORA
Other - Middle Name:
Other - Last Name:MONTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11502 S 4000 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0000
Mailing Address - Country:US
Mailing Address - Phone:801-446-9995
Mailing Address - Fax:
Practice Address - Street 1:11502 S 4000 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-0000
Practice Address - Country:US
Practice Address - Phone:801-446-9995
Practice Address - Fax:
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
UT11631432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist