Provider Demographics
NPI:1497861074
Name:MCWATERS, LYNITA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:LYNITA
Middle Name:KAY
Last Name:MCWATERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5913
Mailing Address - Country:US
Mailing Address - Phone:270-354-5070
Mailing Address - Fax:
Practice Address - Street 1:153 US HIGHWAY 68 E
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7123
Practice Address - Country:US
Practice Address - Phone:270-527-1404
Practice Address - Fax:270-527-1925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist