Provider Demographics
NPI:1891181798
Name:DR. MICHAEL LYONS PC
Entity Type:Organization
Organization Name:DR. MICHAEL LYONS PC
Other - Org Name:DR. MICHAEL LYONS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-449-3663
Mailing Address - Street 1:1558 MONTEITH AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7685
Mailing Address - Country:US
Mailing Address - Phone:662-449-3663
Mailing Address - Fax:662-449-3676
Practice Address - Street 1:1558 MONTEITH AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-7685
Practice Address - Country:US
Practice Address - Phone:662-449-3663
Practice Address - Fax:662-449-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS142963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151139OtherPK