Healthcare Provider Details

I. General information

NPI: 1851092274
Provider Name (Legal Business Name): LYNETTE ANN SHEYACHICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 E HILL RD
GRAND BLANC MI
48439-4803
US

IV. Provider business mailing address

1020 E HILL RD
GRAND BLANC MI
48439-4803
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-4111
  • Fax: 810-233-6360
Mailing address:
  • Phone: 810-232-4111
  • Fax: 810-233-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303009910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: