Individual
JACOB MICHAEL WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 838-5070
Mailing address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26030822A
IN
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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