Healthcare Provider Details

I. General information

NPI: 1780691527
Provider Name (Legal Business Name): DIANE LYNNE TYNDELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N BECK RD
PLYMOUTH MI
48170-3377
US

IV. Provider business mailing address

17493 WESTBROOK DR
LIVONIA MI
48152-2787
US

V. Phone/Fax

Practice location:
  • Phone: 734-354-5950
  • Fax: 734-354-5992
Mailing address:
  • Phone: 734-591-3687
  • Fax: 734-354-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302022364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: