Healthcare Provider Details

I. General information

NPI: 1134561939
Provider Name (Legal Business Name): LANKFORD HOLDINGS MONOGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

IV. Provider business mailing address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

V. Phone/Fax

Practice location:
  • Phone: 623-581-8998
  • Fax: 623-581-6461
Mailing address:
  • Phone: 623-581-8998
  • Fax: 623-581-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: PAUL LANKFORD
Title or Position: PRESIDENT
Credential:
Phone: 623-581-8998