Provider Demographics
NPI:1891468179
Name:CLAVO, LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CLAVO
Suffix:
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 1:1411 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2637
Mailing Address - Country:US
Mailing Address - Phone:770-313-3380
Mailing Address - Fax:
Practice Address - Street 1:3492 WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5608
Practice Address - Country:US
Practice Address - Phone:770-573-7300
Practice Address - Fax:404-973-0637
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist