Provider Demographics
NPI:1306326293
Name:VANLAHR, JONATHAN DUGAN (RPH)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DUGAN
Last Name:VANLAHR
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:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-0207
Mailing Address - Country:US
Mailing Address - Phone:270-547-2855
Mailing Address - Fax:270-547-2857
Practice Address - Street 1:14020 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146-7166
Practice Address - Country:US
Practice Address - Phone:270-547-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007954OtherPHARMACIST LICENSE