MEDICARE: LYNN A WILD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26020119A	IN

General Provider Information

NPI Number	:	1346522042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN A WILD

Provider Business Mailing Address
First Line	:	231 MAPLE LN
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2106
Country	:	US
Telephone Number	:	219-836-5785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 E RIDGE RD
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1461
Country	:	US
Telephone Number	:	219-838-4280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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Directions to “ LYNN A WILD ” Practice Location

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