Provider Demographics
NPI:1639548142
Name:LYNJA INC
Entity type:Organization
Organization Name:LYNJA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-423-3400
Mailing Address - Street 1:3215 8TH ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6564
Mailing Address - Country:US
Mailing Address - Phone:715-423-3401
Mailing Address - Fax:715-432-5523
Practice Address - Street 1:3215 8TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6564
Practice Address - Country:US
Practice Address - Phone:715-423-3401
Practice Address - Fax:715-432-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9350-423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154142OtherPK
WI100049507Medicaid
WI6795320002Medicare NSC