Provider Demographics
NPI:1124287701
Name:PASCHKE, LYNISE R (RPH)
Entity type:Individual
Prefix:
First Name:LYNISE
Middle Name:R
Last Name:PASCHKE
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 1:20671 FOXBORO ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7921
Mailing Address - Country:US
Mailing Address - Phone:828-713-4190
Mailing Address - Fax:
Practice Address - Street 1:1410 E 14 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1550
Practice Address - Country:US
Practice Address - Phone:248-743-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist