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General NPI Number Information
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NPI Number | 1760002455
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Entity Type | Individual
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Provider Name | MICHAEL LYONS PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1701 GALVIN RD S
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City | BELLEVUE
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State | NE
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Zip | 68005-3810
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Country | US
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Telephone | 402-292-2685
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 S 10TH ST
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City | OMAHA
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State | NE
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Zip | 68108-3603
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Country | US
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Telephone | 402-312-7535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10390
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License Number State | NE
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