Healthcare Provider Details

I. General information

NPI: 1184399123
Provider Name (Legal Business Name): CASSANDRA M LYONS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LISBON ST
LISBON FALLS ME
04252-1114
US

IV. Provider business mailing address

77 MALLETT DR
TOPSHAM ME
04086-1300
US

V. Phone/Fax

Practice location:
  • Phone: 207-353-4843
  • Fax:
Mailing address:
  • Phone: 207-729-0806
  • Fax: 207-725-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR70529
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: