Provider Demographics
NPI:1780386995
Name:LYON, CATRICE LOVENE
Entity type:Individual
Prefix:MISS
First Name:CATRICE
Middle Name:LOVENE
Last Name:LYON
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 1:1123 W PERKINS ST APT B
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4664
Mailing Address - Country:US
Mailing Address - Phone:707-472-7675
Mailing Address - Fax:
Practice Address - Street 1:1123 W PERKINS ST APT B
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4664
Practice Address - Country:US
Practice Address - Phone:707-472-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120805183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician