Provider Demographics
NPI:1790008829
Name:KELLOGG, LYNN DENISE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:DENISE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 COLLINS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3229
Mailing Address - Country:US
Mailing Address - Phone:319-377-3338
Mailing Address - Fax:319-377-0729
Practice Address - Street 1:180 COLLINS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3229
Practice Address - Country:US
Practice Address - Phone:319-377-3338
Practice Address - Fax:319-377-0729
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist