Provider Demographics
NPI:1942490099
Name:LYTLE, IRISH E (R PHE)
Entity Type:Individual
Prefix:MS
First Name:IRISH
Middle Name:E
Last Name:LYTLE
Suffix:
Gender:F
Credentials:R PHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALTA RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4902
Mailing Address - Country:US
Mailing Address - Phone:601-442-1684
Mailing Address - Fax:601-442-4806
Practice Address - Street 1:280 JOHN R JUNKIN DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3822
Practice Address - Country:US
Practice Address - Phone:601-442-0086
Practice Address - Fax:601-442-4806
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8010183500000X
MSE 8010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist