Provider Demographics
NPI:1679232284
Name:LUNDIN, SHARON RAE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RAE
Last Name:LUNDIN
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:P.O. BOX 36
Mailing Address - Street 2:
Mailing Address - City:RADIUM SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:88054
Mailing Address - Country:US
Mailing Address - Phone:575-654-3855
Mailing Address - Fax:
Practice Address - Street 1:221 WEST HALL STREET
Practice Address - Street 2:UNITED DRUG
Practice Address - City:HATCH
Practice Address - State:NM
Practice Address - Zip Code:87937
Practice Address - Country:US
Practice Address - Phone:575-267-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist