Provider Demographics
NPI:1275133589
Name:GARRISON, LINDSAY J
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:J
Last Name:GARRISON
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 1:14027 JEM DR
Mailing Address - Street 2:
Mailing Address - City:AVISTON
Mailing Address - State:IL
Mailing Address - Zip Code:62216-3644
Mailing Address - Country:US
Mailing Address - Phone:618-402-8866
Mailing Address - Fax:618-533-1734
Practice Address - Street 1:1212 W MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-5648
Practice Address - Country:US
Practice Address - Phone:618-533-1728
Practice Address - Fax:618-533-1734
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist