Active NPI
Matt Lyall, PHARM D
- Pharmacist
- Elizabethton, TN
National Provider Identifier
1790097962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12208
- Practice address
- 214 Broad St
Elizabethton, TN 37643-2714 - Phone
- (423) 547-2733
- NPI assigned
- Jul 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12208 | TN | Primary |
| Pharmacist | 183500000X | 0202205743 | VA |
Addresses
Primary practice location
214 Broad St
Elizabethton, TN 37643-2714
Mailing address
214 Broad St
Elizabethton, TN 37643-2714
Phone (423) 547-2733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12208 | TN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 0202205743 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278288000000",
"number": "1790097962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 BROAD ST",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376432714",
"telephone_number": "423-547-2733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 BROAD ST",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376432714",
"telephone_number": "423-547-2733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYALL",
"first_name": "MATT",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-05",
"last_updated": "2010-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "12208",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202205743",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabethton, TN
- Hunter Lowe
- LP Elizabethton LLC (Signature HealthCARE of Elizabethton Rehab & Wellness Center)
- Caitlin A Lucas, MSC
- Michael Sean Luedeman, MD
- Lorrie L Lundquist, LCSW, M ED
- Melinda Sue Lynch, RN
- Martin Dentistry (Parkway Dental)
- Martin Dentistry PC (Martin Dentistry of Elizabethton)
- Martin Dentistry PC (Dr. Jack Holly, DDS)
- Olivia Marie Martin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.