Healthcare Provider Details

I. General information

NPI: 1609798040
Provider Name (Legal Business Name): LYON DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CEDAR ST
KUTTAWA KY
42055-6287
US

IV. Provider business mailing address

201 W MAIN ST
EDDYVILLE KY
42038-7752
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-7371
  • Fax: 270-388-2236
Mailing address:
  • Phone: 270-388-2236
  • Fax: 270-388-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWIN L NICKELL
Title or Position: PRESIDENT
Credential: RPH
Phone: 270-388-2236