Provider Demographics
NPI:1578928230
Name:LYONS, DANIEL C (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:LYONS
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:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:POLACCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86042-1014
Mailing Address - Country:US
Mailing Address - Phone:803-463-2802
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 264 MILE POST 388
Practice Address - Street 2:
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042-1014
Practice Address - Country:US
Practice Address - Phone:803-463-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist