Provider Demographics
NPI:1922110410
Name:DANIEL L LYNCH PHARMACY
Entity Type:Organization
Organization Name:DANIEL L LYNCH PHARMACY
Other - Org Name:DANIEL L LYNCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIOTAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-462-2232
Mailing Address - Street 1:173 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3961
Mailing Address - Country:US
Mailing Address - Phone:978-462-2232
Mailing Address - Fax:978-463-0432
Practice Address - Street 1:173 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3961
Practice Address - Country:US
Practice Address - Phone:978-462-2232
Practice Address - Fax:978-463-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MADS19943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0400408Medicaid
2039278OtherPK
2039278OtherPK