Healthcare Provider Details

I. General information

NPI: 1871497438
Provider Name (Legal Business Name): IVY LANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WARREN RD
INDIANA PA
15701-3280
US

IV. Provider business mailing address

641 DOGWOOD RD
CHERRY TREE PA
15724-6606
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-5620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRX460772
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: