Provider Demographics
NPI:1750899399
Name:MCCOLLUM, LYNDE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LYNDE
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W JANEAUX ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3073
Mailing Address - Country:US
Mailing Address - Phone:406-538-6674
Mailing Address - Fax:406-538-6675
Practice Address - Street 1:117 W JANEAUX ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3073
Practice Address - Country:US
Practice Address - Phone:406-538-6674
Practice Address - Fax:406-538-6675
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist