MEDICARE: LYNJA INC

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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy	9165-42	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2138264	OTHER		PK

General Provider Information

NPI Number	:	1104179944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNJA INC

Provider Business Mailing Address
First Line	:	3215 8TH ST S
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-6564
Country	:	US
Telephone Number	:	715-423-3400
Fax Number	:	715-423-5504

Provider Business Practice Location Address
First Line	:	3215 8TH ST S
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-6564
Country	:	US
Telephone Number	:	715-423-3400
Fax Number	:	715-423-5504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON GRUSZYNSKI
Credential	:	R.PH.
Telephone Number	:	715-423-3400

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	01/18/2017

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Directions to “LYNJA INC ” Practice Location

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