Provider Demographics
NPI:1639422066
Name:LYLE, DALEEN ANGELINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DALEEN
Middle Name:ANGELINE
Last Name:LYLE
Suffix:
Gender:F
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 B
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0167
Mailing Address - Country:US
Mailing Address - Phone:253-642-3133
Mailing Address - Fax:253-642-5133
Practice Address - Street 1:101 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-9100
Practice Address - Country:US
Practice Address - Phone:360-642-3133
Practice Address - Fax:360-642-5133
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67946183500000X
WAPH60296001183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist