Provider Demographics
NPI:1104945898
Name:LYONS, THEADORE II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THEADORE
Middle Name:
Last Name:LYONS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6084 APPLE TREE DR
Mailing Address - Street 2:STE 11
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0305
Mailing Address - Country:US
Mailing Address - Phone:901-737-9806
Mailing Address - Fax:
Practice Address - Street 1:6084 APPLE TREE DR
Practice Address - Street 2:STE 11
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0305
Practice Address - Country:US
Practice Address - Phone:901-779-6500
Practice Address - Fax:901-779-6555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN10120183500000X
TN10120207Q00000X
ARPD10428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty