Healthcare Provider Details

I. General information

NPI: 1184168502
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER LYTLE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 E LAMAR ST
AMERICUS GA
31709-3845
US

IV. Provider business mailing address

114 CONLEY DR
BONAIRE GA
31005-3811
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-2641
  • Fax:
Mailing address:
  • Phone: 706-833-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: