Provider Demographics
NPI:1548673080
Name:LUND, PAULA (RPH)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:LUND
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 1:3430 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0840
Mailing Address - Country:US
Mailing Address - Phone:209-527-4600
Mailing Address - Fax:209-527-1086
Practice Address - Street 1:3430 TULLY RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0840
Practice Address - Country:US
Practice Address - Phone:209-527-4600
Practice Address - Fax:209-527-1086
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist