Provider Demographics
NPI:1154919587
Name:LUNDQUIST, PAMELA FITZGERALD (PHARMD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:FITZGERALD
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 WORTHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9585
Mailing Address - Country:US
Mailing Address - Phone:502-608-6201
Mailing Address - Fax:
Practice Address - Street 1:3905 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1414
Practice Address - Country:US
Practice Address - Phone:502-975-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist