Provider Demographics
NPI:1104426188
Name:LANZRATH, TIFFANY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:LANZRATH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8776
Mailing Address - Country:US
Mailing Address - Phone:620-441-8478
Mailing Address - Fax:
Practice Address - Street 1:3084 N MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7359
Practice Address - Country:US
Practice Address - Phone:316-347-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist