Healthcare Provider Details

I. General information

NPI: 1780758052
Provider Name (Legal Business Name): LYNN DALRYMPLE PARDO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

4749 CENTRAL AVE
INDIANAPOLIS IN
46205-1828
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2144
  • Fax:
Mailing address:
  • Phone: 317-925-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26017415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: