Provider Demographics
NPI:1104119221
Name:CALVERT, LYNNE (LYNNE CALVERT RPH)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:LYNNE CALVERT RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:EXMORE
Mailing Address - State:VA
Mailing Address - Zip Code:23350-0850
Mailing Address - Country:US
Mailing Address - Phone:757-442-8542
Mailing Address - Fax:
Practice Address - Street 1:40530 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:EXMORE
Practice Address - State:VA
Practice Address - Zip Code:23350-0850
Practice Address - Country:US
Practice Address - Phone:757-442-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist