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NPI Code Detail

MEDICARE: DR. THOMAS EDWARD LACKNER PHARMD

MEDICARE:  DR. THOMAS EDWARD LACKNER  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist1131677MN

General Provider Information

NPI Number : 1215934344
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS EDWARD LACKNER PHARMD
Provider Business Mailing Address
First Line : 1372 138TH LN NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-4095
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1372 138TH LN NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-4095
Country : US
Telephone Number : 763-755-3662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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Directions to “ DR. THOMAS EDWARD LACKNER PHARMD” Practice Location

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