Healthcare Provider Details

I. General information

NPI: 1871695767
Provider Name (Legal Business Name): JOHN P LYNN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 W INDUSTRIAL DR
LOUISIANA MO
63353-3868
US

IV. Provider business mailing address

45058 HIGHWAY CC
CENTER MO
63436-2166
US

V. Phone/Fax

Practice location:
  • Phone: 800-818-1632
  • Fax:
Mailing address:
  • Phone: 800-818-1632
  • Fax: 800-867-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2001024807
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: