Provider Demographics
NPI:1386991370
Name:LUSSON, AIMEE LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNNE
Last Name:LUSSON
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 1:1900 HI LINE DR
Mailing Address - Street 2:#401
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 HI LINE DR
Practice Address - Street 2:#401
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-3333
Practice Address - Country:US
Practice Address - Phone:312-841-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist