Provider Demographics
NPI:1922453893
Name:REYNOSO, LYNDON B (RPH)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:B
Last Name:REYNOSO
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 1:3191 S VAUGHN WAY # 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3505
Mailing Address - Country:US
Mailing Address - Phone:720-748-2449
Mailing Address - Fax:
Practice Address - Street 1:3191 S VAUGHN WAY
Practice Address - Street 2:102
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-748-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist