Provider Demographics
NPI:1124328612
Name:DRAKE, LYNNE ELDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ELDON
Last Name:DRAKE
Suffix:
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 1:1867 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3769
Mailing Address - Country:US
Mailing Address - Phone:760-434-0171
Mailing Address - Fax:
Practice Address - Street 1:1755 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4546
Practice Address - Country:US
Practice Address - Phone:760-631-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH24630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist