Provider Demographics
NPI:1093890956
Name:POLLARD, LYNDA
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:POLLARD
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:GREENVIEW
Mailing Address - State:CA
Mailing Address - Zip Code:96037-0209
Mailing Address - Country:US
Mailing Address - Phone:530-468-5707
Mailing Address - Fax:530-467-5111
Practice Address - Street 1:511 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:CA
Practice Address - Zip Code:96027
Practice Address - Country:US
Practice Address - Phone:530-467-5335
Practice Address - Fax:530-467-5111
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH21928183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA369010Medicaid
CA0199400001Medicare ID - Type UnspecifiedMEDICARE NUMBER