Provider Demographics
NPI:1255937967
Name:HYNES, LISA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:HYNES
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 1:20070 HOLT AVE W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6864
Mailing Address - Country:US
Mailing Address - Phone:952-240-4598
Mailing Address - Fax:
Practice Address - Street 1:425 MAIN ST W
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-2044
Practice Address - Country:US
Practice Address - Phone:507-263-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist