Provider Demographics
NPI:1811204910
Name:CARLSON, LYNDSAY ELISE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSAY
Middle Name:ELISE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:LYNDSAY
Other - Middle Name:ELISE
Other - Last Name:WORMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:52 HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-763-6494
Mailing Address - Fax:607-240-2715
Practice Address - Street 1:30 HARRISON STREET SUITE 250
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-763-6494
Practice Address - Fax:607-270-2715
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03129405-1183500000X
NY056328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist