Provider Demographics
NPI:1871805242
Name:KOCH, LYNETTE KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:KAY
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2924
Mailing Address - Country:US
Mailing Address - Phone:193-523-1203
Mailing Address - Fax:319-352-5720
Practice Address - Street 1:110 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677
Practice Address - Country:US
Practice Address - Phone:193-523-1203
Practice Address - Fax:319-352-5720
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist