Provider Demographics
NPI:1508645979
Name:LYNCH, JILL LISA (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LISA
Last Name:LYNCH
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 1:9 CHAD CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3228
Mailing Address - Country:US
Mailing Address - Phone:319-354-1204
Mailing Address - Fax:
Practice Address - Street 1:1900 JAMES ST STE 10
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1895
Practice Address - Country:US
Practice Address - Phone:319-354-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist