Provider Demographics
NPI:1417019811
Name:HOSTETLER, LYNN D (RPH)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:D
Last Name:HOSTETLER
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 1:6555 N STATE ROAD 59
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-8229
Mailing Address - Country:US
Mailing Address - Phone:812-448-8302
Mailing Address - Fax:812-448-1855
Practice Address - Street 1:22 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2537
Practice Address - Country:US
Practice Address - Phone:812-446-2381
Practice Address - Fax:812-448-1855
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26011851A1835P1200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy