Provider Demographics
NPI:1831364009
Name:LONGBELLA ROBERTS, LANI K (RPH)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:K
Last Name:LONGBELLA ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-2539
Mailing Address - Country:US
Mailing Address - Phone:218-894-2242
Mailing Address - Fax:218-894-2013
Practice Address - Street 1:49725 CTY RD #83
Practice Address - Street 2:SUITE 100
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479
Practice Address - Country:US
Practice Address - Phone:218-894-8761
Practice Address - Fax:218-894-8762
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist