Provider Demographics
NPI:1053777060
Name:LYNCH, HUGH IV (RPH)
Entity type:Individual
Prefix:MR
First Name:HUGH
Middle Name:
Last Name:LYNCH
Suffix:IV
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6006
Mailing Address - Country:US
Mailing Address - Phone:706-475-5563
Mailing Address - Fax:706-475-5565
Practice Address - Street 1:1510 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6006
Practice Address - Country:US
Practice Address - Phone:706-475-5563
Practice Address - Fax:706-475-5565
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist