Provider Demographics
NPI:1902412596
Name:LYOCK, YOHANNA GAIYA
Entity Type:Individual
Prefix:
First Name:YOHANNA
Middle Name:GAIYA
Last Name:LYOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6501
Mailing Address - Country:US
Mailing Address - Phone:325-942-6658
Mailing Address - Fax:325-949-6654
Practice Address - Street 1:3121 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6501
Practice Address - Country:US
Practice Address - Phone:325-942-6658
Practice Address - Fax:325-949-6654
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist