Provider Demographics
NPI:1518137983
Name:LYNDAKER, ROLAND JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:JOHN
Last Name:LYNDAKER
Suffix:
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 1:4071 MINER RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9619
Mailing Address - Country:US
Mailing Address - Phone:315-597-5133
Mailing Address - Fax:
Practice Address - Street 1:815 CANANDAIGUA RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2003
Practice Address - Country:US
Practice Address - Phone:315-781-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist