Provider Demographics
NPI:1093082190
Name:LYON, CHARLES STERLING (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STERLING
Last Name:LYON
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 1:1920 S CHELTON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-5304
Mailing Address - Country:US
Mailing Address - Phone:719-570-1618
Mailing Address - Fax:719-570-7181
Practice Address - Street 1:1920 S CHELTON RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-5304
Practice Address - Country:US
Practice Address - Phone:719-570-1618
Practice Address - Fax:719-570-7181
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist