Provider Demographics
NPI:1184168502
Name:LYTLE, MICHAEL CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:LYTLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CONLEY DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3811
Mailing Address - Country:US
Mailing Address - Phone:706-833-1216
Mailing Address - Fax:
Practice Address - Street 1:1442 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3845
Practice Address - Country:US
Practice Address - Phone:229-924-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist