Provider Demographics
NPI:1992956718
Name:LYON, MARTHA (RPH)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:300 S MIDDLETON ST
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-0548
Mailing Address - Country:US
Mailing Address - Phone:910-948-2921
Mailing Address - Fax:910-948-3477
Practice Address - Street 1:300 S MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325-8407
Practice Address - Country:US
Practice Address - Phone:910-948-2921
Practice Address - Fax:910-948-3477
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist