Provider Demographics
NPI:1659860666
Name:KOEHN, LYNNE A
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:KOEHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 CIRCLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2979
Mailing Address - Country:US
Mailing Address - Phone:620-408-5296
Mailing Address - Fax:
Practice Address - Street 1:1905 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2304
Practice Address - Country:US
Practice Address - Phone:620-225-0872
Practice Address - Fax:620-225-0717
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist