Provider Demographics
NPI:1366725137
Name:WESCOAT, LYNETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:WESCOAT
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 1:505 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1651
Mailing Address - Country:US
Mailing Address - Phone:816-884-1891
Mailing Address - Fax:816-884-1897
Practice Address - Street 1:505 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1651
Practice Address - Country:US
Practice Address - Phone:816-884-1891
Practice Address - Fax:816-884-1897
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist