MEDICARE: DR. EMILY LYONS 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
1	183500000X	Pharmacist	5302035575	MI

General Provider Information

NPI Number	:	1760088389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY LYONS PHARM.D.

Provider Business Mailing Address
First Line	:	2000 HARWOOD AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-4004
Country	:	US
Telephone Number	:	616-822-0138
Fax Number	:

Provider Business Practice Location Address
First Line	:	4665 44TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-4136
Country	:	US
Telephone Number	:	616-977-9700
Fax Number	:

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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