=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205155389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL J LYONS PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2010
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4575 CAMINO DE LA PLZ STE 106
-----------------------------------------------------
City | SAN YSIDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92173-3157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-407-5555
-----------------------------------------------------
Fax | 619-407-6718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4575 CAMINO DE LA PLZ STE 106
-----------------------------------------------------
City | SAN YSIDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92173-3157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-407-5555
-----------------------------------------------------
Fax | 619-407-6718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 55205
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------