Healthcare Provider Details

I. General information

NPI: 1104179944
Provider Name (Legal Business Name): LYNJA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 8TH ST S
WISCONSIN RAPIDS WI
54494-6564
US

IV. Provider business mailing address

3215 8TH ST S
WISCONSIN RAPIDS WI
54494-6564
US

V. Phone/Fax

Practice location:
  • Phone: 715-423-3400
  • Fax: 715-423-5504
Mailing address:
  • Phone: 715-423-3400
  • Fax: 715-423-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number9165-42
License Number StateWI

VIII. Authorized Official

Name: JASON GRUSZYNSKI
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 715-423-3400