Provider Demographics
NPI:1013292697
Name:LEDBETTER, LYNNE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:LEDBETTER
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 1:776 JEFFCO BLVD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1415
Mailing Address - Country:US
Mailing Address - Phone:636-296-9490
Mailing Address - Fax:
Practice Address - Street 1:776 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1415
Practice Address - Country:US
Practice Address - Phone:636-296-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist