Provider Demographics
NPI:1295991446
Name:LYBOULT, ELIZABETH ANN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:LYBOULT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4591 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT S8
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1946
Mailing Address - Country:US
Mailing Address - Phone:315-264-1100
Mailing Address - Fax:
Practice Address - Street 1:845 ROUTES 5 & 20
Practice Address - Street 2:TLC HEALTH NETWORK LAKE SHORE HEALTH CARE CENTER
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081
Practice Address - Country:US
Practice Address - Phone:716-951-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist