Provider Demographics
NPI:1336578327
Name:BASER, LYNDELL CORIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNDELL
Middle Name:CORIN
Last Name:BASER
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 1:117 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2224
Mailing Address - Country:US
Mailing Address - Phone:208-783-0920
Mailing Address - Fax:
Practice Address - Street 1:117 N HILL ST
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2224
Practice Address - Country:US
Practice Address - Phone:208-783-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist