Provider Demographics
NPI:1932654878
Name:LYCHWICK, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LYCHWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7922
Mailing Address - Country:US
Mailing Address - Phone:480-592-9465
Mailing Address - Fax:
Practice Address - Street 1:1415 W RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5829
Practice Address - Country:US
Practice Address - Phone:520-293-2995
Practice Address - Fax:520-293-7534
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI012333390200000X
AZS024119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program