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General NPI Number Information
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NPI Number | 1578849683
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Entity Type | Individual
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Provider Name | KRISTA KAY VAN LANCKER RPH
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 09/07/2020
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Provider Practice Location Address
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Address Line | 3159 W COLORADO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2040
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Country | US
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Telephone | 719-475-9030
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Fax | 719-381-4453
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Provider Business Mailing Address
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Address Line | 2414 MESA CREST GRV
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-1816
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Country | US
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Telephone | 719-290-2458
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Fax | 719-381-4453
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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 | 14757
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License Number State | CO
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