MEDICARE: MR. LYNN G WILTRAKIS RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26016285A	IN

General Provider Information

NPI Number	:	1043591092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LYNN G WILTRAKIS RPH.

Provider Business Mailing Address
First Line	:	12115 W 95TH PL
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9537
Country	:	US
Telephone Number	:	219-365-3135
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 W GLEN PARK AVE
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1511
Country	:	US
Telephone Number	:	219-924-2703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2011
Last Update Date	:	09/05/2011

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