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General NPI Number Information
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NPI Number | 1225470123
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Entity Type | Individual
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Provider Name | REBEKAH LAUTENSACK RPH
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 900 UNION BLVD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2221
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Country | US
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Telephone | 937-836-5204
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 DEAGLEWAY DR APT F
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City | FAIRBORN
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State | OH
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Zip | 45324-9479
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Country | US
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Telephone | 315-591-5754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3233144
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License Number State | OH
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