Provider Demographics
NPI:1194928473
Name:BALLANDBY, LANE ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:LANE
Middle Name:ALLEN
Last Name:BALLANDBY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:50459
Mailing Address - Country:US
Mailing Address - Phone:641-324-2622
Mailing Address - Fax:
Practice Address - Street 1:140 W 14TH ST
Practice Address - Street 2:BROWER DRUG CO
Practice Address - City:ST ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472
Practice Address - Country:US
Practice Address - Phone:641-713-4381
Practice Address - Fax:641-713-2386
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15695183500000X
MN114593183500000X
AK715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist