Provider Demographics
NPI:1083908065
Name:TAKAHASHI, LYLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VIA VISTA VERDE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4946
Mailing Address - Country:US
Mailing Address - Phone:805-938-1224
Mailing Address - Fax:805-938-1224
Practice Address - Street 1:223 E BETTERAVIA RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7803
Practice Address - Country:US
Practice Address - Phone:805-922-7184
Practice Address - Fax:805-922-7184
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist