Healthcare Provider Details

I. General information

NPI: 1043228174
Provider Name (Legal Business Name): PATRICK MICHAEL LYNCH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HAZEN ST SUITE 102
PAW PAW MI
49079-1040
US

IV. Provider business mailing address

404 HAZEN ST SUITE 102
PAW PAW MI
49079-1040
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-4701
  • Fax: 269-657-4553
Mailing address:
  • Phone: 269-657-4701
  • Fax: 269-657-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302021179
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: