Provider Demographics
NPI:1053618033
Name:FISK-LYNES, LINDA FISK (RPH)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FISK
Last Name:FISK-LYNES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:395 N HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3919
Mailing Address - Country:US
Mailing Address - Phone:843-899-6601
Mailing Address - Fax:843-899-6640
Practice Address - Street 1:395 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3919
Practice Address - Country:US
Practice Address - Phone:843-899-6601
Practice Address - Fax:843-899-6640
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist