Healthcare Provider Details

I. General information

NPI: 1235503707
Provider Name (Legal Business Name): LYMAN HOLYOAK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 S ANCONA AVE STE 140
EAGLE ID
83616-5539
US

IV. Provider business mailing address

1079 S ANCONA AVE
EAGLE ID
83616-5538
US

V. Phone/Fax

Practice location:
  • Phone: 208-229-5539
  • Fax: 208-485-7400
Mailing address:
  • Phone: 208-229-5539
  • Fax: 208-485-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6314
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: