Provider Demographics
NPI:1518218155
Name:BERDON, SONDRA K (RPH)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:K
Last Name:BERDON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 VIA LAPIZ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3910
Mailing Address - Country:US
Mailing Address - Phone:858-453-8403
Mailing Address - Fax:
Practice Address - Street 1:4935 VIA LAPIZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-3910
Practice Address - Country:US
Practice Address - Phone:858-453-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist