Provider Demographics
NPI:1548547227
Name:LADNER, ANTHONY JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:LADNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:JOHN
Other - Last Name:LADNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:24760 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671
Mailing Address - Country:US
Mailing Address - Phone:218-679-0173
Mailing Address - Fax:218-679-0189
Practice Address - Street 1:24760 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-0173
Practice Address - Fax:218-679-0189
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist