Provider Demographics
NPI:1235503707
Name:HOLYOAK, LYMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYMAN
Middle Name:
Last Name:HOLYOAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8306
Mailing Address - Country:US
Mailing Address - Phone:208-323-0067
Mailing Address - Fax:
Practice Address - Street 1:8455 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8306
Practice Address - Country:US
Practice Address - Phone:208-323-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist