Provider Demographics
NPI:1235259649
Name:LAMOUREUX, J. LYLE (RPH)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:LYLE
Last Name:LAMOUREUX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:LYLE
Other - Last Name:LAMOUREUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:7290 BUTTE VIS
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-9770
Mailing Address - Country:US
Mailing Address - Phone:928-772-5406
Mailing Address - Fax:
Practice Address - Street 1:3100 GLASSFORD HILL ROAD
Practice Address - Street 2:FRYS FOOD AND DRUGS
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-445-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2962183500000X
AZSO14109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist