Provider Demographics
NPI:1861714834
Name:GANNON, LYNN A (RPH)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:GANNON
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 1:120 FIELDCREST AVE
Mailing Address - Street 2:C/O OMNICARE OF EDISON
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3656
Mailing Address - Country:US
Mailing Address - Phone:732-346-2600
Mailing Address - Fax:732-225-5168
Practice Address - Street 1:120 FIELDCREST AVE
Practice Address - Street 2:C/O OMNICARE OF EDISON
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3656
Practice Address - Country:US
Practice Address - Phone:732-346-2600
Practice Address - Fax:732-225-5168
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01843500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist