MEDICARE: LYNN BALTIMORE BLUE 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	13185	NC

General Provider Information

NPI Number	:	1841464294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN BALTIMORE BLUE RPH

Provider Business Mailing Address
First Line	:	PO BOX 3682
Second Line	:	203 BRIDGERS AVE
City	:	TOPSAIL BEACH
State	:	NC
Zip	:	28445-9831
Country	:	US
Telephone Number	:	910-328-9901
Fax Number	:	910-328-9901

Provider Business Practice Location Address
First Line	:	203 BRIDGERS AVE
Second Line	:
City	:	TOPSAIL BEACH
State	:	NC
Zip	:	28445-9831
Country	:	US
Telephone Number	:	910-328-9901
Fax Number	:	910-328-9901

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	07/06/2009

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