Provider Demographics
NPI:1164844155
Name:LYNN, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:IA
Mailing Address - Zip Code:50851-1237
Mailing Address - Country:US
Mailing Address - Phone:641-333-2260
Mailing Address - Fax:641-333-2506
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-1237
Practice Address - Country:US
Practice Address - Phone:641-333-2260
Practice Address - Fax:641-333-2506
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist