Healthcare Provider Details

I. General information

NPI: 1710360565
Provider Name (Legal Business Name): MICHAEL LYON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49908 JEFFERSON ST
INDIO CA
92201-9720
US

IV. Provider business mailing address

49908 JEFFERSON ST
INDIO CA
92201-9720
US

V. Phone/Fax

Practice location:
  • Phone: 760-771-4524
  • Fax: 760-777-4269
Mailing address:
  • Phone: 760-771-4524
  • Fax: 760-777-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: