Provider Demographics
NPI:1851646806
Name:LA LONDE, PAMELA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:LA LONDE
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 1:3001 BRIDGEWAY
Mailing Address - Street 2:#K-139
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1408
Mailing Address - Country:US
Mailing Address - Phone:415-827-6511
Mailing Address - Fax:
Practice Address - Street 1:300 VINTAGE WAY
Practice Address - Street 2:(COSTCO PHARMACY #141)
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5007
Practice Address - Country:US
Practice Address - Phone:415-899-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40191183500000X
NV09349183500000X
IL051.039282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist