Healthcare Provider Details

I. General information

NPI: 1053304584
Provider Name (Legal Business Name): ANN LYNN LADY R. PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 LIMERICK CT
HUMMELSTOWN PA
17036-9024
US

IV. Provider business mailing address

1105 LIMERICK CT
HUMMELSTOWN PA
17036-9024
US

V. Phone/Fax

Practice location:
  • Phone: 717-220-1102
  • Fax:
Mailing address:
  • Phone: 717-220-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031562L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: