Provider Demographics
NPI:1871917823
Name:FOTIS, LYNN K (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:K
Last Name:FOTIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3234
Mailing Address - Country:US
Mailing Address - Phone:608-203-6480
Mailing Address - Fax:
Practice Address - Street 1:7208 HUBBARD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3234
Practice Address - Country:US
Practice Address - Phone:608-203-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16996-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist