Provider Demographics
NPI:1205155389
Name:LYONS, DANIEL J (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:LYONS
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 1:642 PALOMAR ST STE 410
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2629
Mailing Address - Country:US
Mailing Address - Phone:619-407-5555
Mailing Address - Fax:619-407-6718
Practice Address - Street 1:642 PALOMAR ST STE 410
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2629
Practice Address - Country:US
Practice Address - Phone:619-944-6033
Practice Address - Fax:619-407-6718
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55205183500000X
NV15982183500000X
PA438230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902442387Medicaid