Organization
LYON DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN LYNN NICKELL RPH. (PRESIDENT)
(270) 388-2236
Entity
Organization
Contact information
Practice address
201 MAIN ST, EDDYVILLE, KY 42038-7752
(270) 388-2236
(270) 388-0900
Mailing address
201 MAIN ST, EDDYVILLE, KY 42038-7752
(270) 388-2236
(270) 388-0900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P00293
KY
333600000X
Pharmacy
Primary
P00293
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801958
NABP #
—
05
—
54032735
—
KY
05
—
90040726
—
KY
Enumeration date
05/27/2006
Last updated
11/06/2015
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