Provider Demographics
NPI:1942804315
Name:DAVIDSON, LYNDON AARON (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:AARON
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 WILLOWDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4755
Mailing Address - Country:US
Mailing Address - Phone:513-488-3973
Mailing Address - Fax:
Practice Address - Street 1:4996 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-6054
Practice Address - Country:US
Practice Address - Phone:937-233-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist