Provider Demographics
NPI:1821434325
Name:WALZ, LYNN KEITH (R PH)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:KEITH
Last Name:WALZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5104
Mailing Address - Country:US
Mailing Address - Phone:970-247-2921
Mailing Address - Fax:970-259-3847
Practice Address - Street 1:6 TOWN PLZ
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5104
Practice Address - Country:US
Practice Address - Phone:970-247-2921
Practice Address - Fax:970-259-3847
Is Sole Proprietor?:No
Enumeration Date:2013-05-12
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist