Provider Demographics
NPI:1699499202
Name:SASS, LYNDSEY LORREN (PHARMD)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:LORREN
Last Name:SASS
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 1:4657 PARKSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3205
Mailing Address - Country:US
Mailing Address - Phone:313-909-4153
Mailing Address - Fax:
Practice Address - Street 1:22505 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2237
Practice Address - Country:US
Practice Address - Phone:734-676-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist