Provider Demographics
NPI:1851421101
Name:DAVIS, LYNN MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 KENNEDY DR APT 904
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2117
Mailing Address - Country:US
Mailing Address - Phone:801-865-6112
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR # A050
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34873183500000X
UT4742181-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist