Provider Demographics
NPI:1932417078
Name:CHAVEZ, LYNN PHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:PHAN
Last Name:CHAVEZ
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 1:10418 W EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4651
Mailing Address - Country:US
Mailing Address - Phone:623-251-0259
Mailing Address - Fax:
Practice Address - Street 1:1300 S WATSON RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6303
Practice Address - Country:US
Practice Address - Phone:623-691-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist