Provider Demographics
NPI:1871695767
Name:LYNN, JOHN P (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LYNN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45058 HIGHWAY CC
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:MO
Mailing Address - Zip Code:63436-2166
Mailing Address - Country:US
Mailing Address - Phone:800-818-1632
Mailing Address - Fax:800-867-4853
Practice Address - Street 1:3651 W INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-3868
Practice Address - Country:US
Practice Address - Phone:800-818-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist