Provider Demographics
NPI:1174984215
Name:BALL, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 TEATICKET HWY
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5659
Mailing Address - Country:US
Mailing Address - Phone:508-457-1185
Mailing Address - Fax:
Practice Address - Street 1:137 TEATICKET HWY
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5659
Practice Address - Country:US
Practice Address - Phone:508-457-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist