Provider Demographics
NPI:1821442153
Name:LYHKA5 LLC
Entity Type:Organization
Organization Name:LYHKA5 LLC
Other - Org Name:ANNA'S DULUTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:678-622-9234
Mailing Address - Street 1:4470 SATELLITE BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8852
Mailing Address - Country:US
Mailing Address - Phone:470-268-8922
Mailing Address - Fax:470-268-8927
Practice Address - Street 1:4470 SATELLITE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8852
Practice Address - Country:US
Practice Address - Phone:470-268-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE010287183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176035AMedicaid