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NPI Code Detail

MEDICARE: LYNN NANOS RPH

MEDICARE: LYNN NANOS 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
1183500000XPharmacist051041218IL

General Provider Information

NPI Number : 1659652410
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN NANOS RPH
Provider Business Mailing Address
First Line : 16 TOURNAMENT DR N
Second Line :
City : HAWTHORN WOODS
State : IL
Zip : 60047-8401
Country : US
Telephone Number : 847-865-5283
Fax Number :
Provider Business Practice Location Address
First Line : 1285 S RAND RD
Second Line :
City : LAKE ZURICH
State : IL
Zip : 60047-2960
Country : US
Telephone Number : 847-438-8565
Fax Number : 847-438-1064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 09/06/2011

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