Provider Demographics
NPI:1467098657
Name:PONDER, LUKE HAROLD JR (RPH)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:HAROLD
Last Name:PONDER
Suffix:JR
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 1:25780 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1443
Mailing Address - Country:US
Mailing Address - Phone:248-471-2058
Mailing Address - Fax:248-471-2082
Practice Address - Street 1:25780 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1443
Practice Address - Country:US
Practice Address - Phone:248-471-2058
Practice Address - Fax:248-471-2082
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist