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General NPI Number Information
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NPI Number | 1669758413
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Entity Type | Individual
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Provider Name | JOSEPH D VAN LANCKER BS PHARM
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Gender | Male
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 1304 CHINOOK LN
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City | PUEBLO
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State | CO
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Zip | 81001-1851
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Country | US
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Telephone | 719-296-6937
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Fax | 719-543-6439
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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 | 719-235-8590
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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 | 14784
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License Number State | CO
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