Provider Demographics
NPI:1528389335
Name:LYLES, MARCUS ALEJO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ALEJO
Last Name:LYLES
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 1:3071 S PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3239
Mailing Address - Country:US
Mailing Address - Phone:901-758-1171
Mailing Address - Fax:901-366-0224
Practice Address - Street 1:7466 CORDOVA CLUB DR E
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-1830
Practice Address - Country:US
Practice Address - Phone:901-758-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000010512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist