Provider Demographics
NPI:1821689530
Name:LYON, BRITTANY MELISSA
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MELISSA
Last Name:LYON
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:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0780
Mailing Address - Country:US
Mailing Address - Phone:903-322-1315
Mailing Address - Fax:903-322-4336
Practice Address - Street 1:1220 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-1315
Practice Address - Fax:903-322-4336
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist