Healthcare Provider Details

I. General information

NPI: 1255386587
Provider Name (Legal Business Name): LYNNE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903A W STOCKTON ST
EDMONTON KY
42129
US

IV. Provider business mailing address

PO BOX 360
EDMONTON KY
42129-0360
US

V. Phone/Fax

Practice location:
  • Phone: 270-432-2822
  • Fax: 270-432-7278
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07120
License Number StateKY

VIII. Authorized Official

Name: JENNIFER WOOD
Title or Position: OWNER
Credential: RPH
Phone: 270-432-2822