Provider Demographics
NPI:1891246179
Name:LYNE, KRISTINE III (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LYNE
Suffix:III
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DEFOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1930
Mailing Address - Country:US
Mailing Address - Phone:908-273-0360
Mailing Address - Fax:
Practice Address - Street 1:121 MCCLEAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4655
Practice Address - Country:US
Practice Address - Phone:718-447-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02356400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty