Provider Demographics
NPI:1811362882
Name:JANZ, EUGENE (D PH)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:JANZ
Suffix:
Gender:M
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 NW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2355
Mailing Address - Country:US
Mailing Address - Phone:580-354-7275
Mailing Address - Fax:
Practice Address - Street 1:2030 NW 82ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2355
Practice Address - Country:US
Practice Address - Phone:580-354-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist