Healthcare Provider Details

I. General information

NPI: 1699024729
Provider Name (Legal Business Name): DANA LYNN LAUTZENHEISER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA LYNN KOCH PHARMD

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 FORTMAN DR
SAINT MARYS OH
45885-1871
US

IV. Provider business mailing address

610 W AUGLAIZE ST
WAPAKONETA OH
45895-1410
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-8930
  • Fax: 419-394-8885
Mailing address:
  • Phone: 419-303-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03132071
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: