Provider Demographics
NPI:1972119576
Name:HINNENKAMP, LYNNE BURTON (PHARMD, BS PHARM)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:BURTON
Last Name:HINNENKAMP
Suffix:
Gender:F
Credentials:PHARMD, BS PHARM
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:KAY
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 OAK PARK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2024
Mailing Address - Country:US
Mailing Address - Phone:757-773-6978
Mailing Address - Fax:
Practice Address - Street 1:3452 LAKE LYNDA DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1481
Practice Address - Country:US
Practice Address - Phone:757-773-6978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPHT000123-T183500000X
NC28689183500000X
VA0202009395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist