Provider Demographics
NPI:1790192995
Name:PON, LYNDA (RPH)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:
Last Name:PON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:MIULING
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3006 ENCHANTED WALK
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2669
Mailing Address - Country:US
Mailing Address - Phone:530-301-4830
Mailing Address - Fax:
Practice Address - Street 1:3521 DEL PASO RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2800
Practice Address - Country:US
Practice Address - Phone:916-515-1866
Practice Address - Fax:916-515-0746
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist