Healthcare Provider Details

I. General information

NPI: 1326972001
Provider Name (Legal Business Name): LYNN EL DAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 E 3RD ST
BLOOMINGTON IN
47401-5433
US

IV. Provider business mailing address

880 S WESTGATE DR APT 113
BLOOMINGTON IN
47404-8050
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-1419
  • Fax:
Mailing address:
  • Phone: 812-581-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26031884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: