Provider Demographics
NPI:1851649065
Name:LYNCH, LUKAS LAWRENCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUKAS
Middle Name:LAWRENCE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19412 QUEEN CIR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5035
Mailing Address - Country:US
Mailing Address - Phone:763-843-4044
Mailing Address - Fax:
Practice Address - Street 1:1300 STATE HIGHWAY 55 NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-4321
Practice Address - Country:US
Practice Address - Phone:763-682-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120874OtherLICENSE NUMBER