Provider Demographics
NPI:1396870648
Name:LASEMAN, LYNN F (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:F
Last Name:LASEMAN
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1705
Mailing Address - Country:US
Mailing Address - Phone:815-756-5441
Mailing Address - Fax:
Practice Address - Street 1:810 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4410
Practice Address - Country:US
Practice Address - Phone:815-758-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist