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NPI Code Detail

MEDICARE: DR. KELLY NOELLE LYNN PHARM D

MEDICARE:  DR. KELLY NOELLE LYNN  PHARM D
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
1183500000XPharmacist11765SC
2183500000XPharmacist19253NC

General Provider Information

NPI Number : 1548518533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY NOELLE LYNN PHARM D
Provider Business Mailing Address
First Line : 4310 HARD SCRABBLE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-9423
Country : US
Telephone Number : 803-865-6682
Fax Number : 803-865-5850
Provider Business Practice Location Address
First Line : 4310 HARD SCRABBLE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-9423
Country : US
Telephone Number : 803-865-6682
Fax Number : 803-865-5850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2012
Last Update Date : 08/22/2012

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Directions to “ DR. KELLY NOELLE LYNN PHARM D” Practice Location

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