Provider Demographics
NPI:1538343819
Name:BELOHLAVEK, LANCE J (PHARMD)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:J
Last Name:BELOHLAVEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 TIMBERHAVEN DR S
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8703
Mailing Address - Country:US
Mailing Address - Phone:701-425-2497
Mailing Address - Fax:
Practice Address - Street 1:1659 TIMBERHAVEN DR S
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8703
Practice Address - Country:US
Practice Address - Phone:701-425-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5108183500000X
SD5501183500000X
WY3137183500000X
CO17405183500000X
MT6234183500000X
MN119165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist