Provider Demographics
NPI:1184399123
Name:LYONS, CASSANDRA M (PHARMD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MALLETT DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1300
Mailing Address - Country:US
Mailing Address - Phone:207-729-0806
Mailing Address - Fax:207-725-8293
Practice Address - Street 1:575 LISBON ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1114
Practice Address - Country:US
Practice Address - Phone:207-353-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist