Provider Demographics
NPI:1316507072
Name:LYNN, AMY THOMPSON (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:THOMPSON
Last Name:LYNN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 SNOWS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2706
Mailing Address - Country:US
Mailing Address - Phone:770-601-1577
Mailing Address - Fax:
Practice Address - Street 1:2420 LINWOOD DR STE 3
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6122
Practice Address - Country:US
Practice Address - Phone:870-236-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY40541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist