Provider Demographics
NPI:1942541701
Name:LEAF, LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:LEAF
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 1:10961 CLUB WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5866
Mailing Address - Country:US
Mailing Address - Phone:763-528-2975
Mailing Address - Fax:
Practice Address - Street 1:14177 ASH BLVD
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8945
Practice Address - Country:US
Practice Address - Phone:763-360-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN113656OtherMN PHARMACIST LICENSE