=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598196883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID LAHNER RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2013
-----------------------------------------------------
Last Update Date | 12/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 SUPERIOR AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-459-2637
-----------------------------------------------------
Fax | 920-459-2644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 SUPERIOR AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-459-2637
-----------------------------------------------------
Fax | 920-459-2644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 9571-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------