Provider Demographics
NPI:1306477617
Name:LUNDBLAD, YANA GRACE (PHARMD)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:GRACE
Last Name:LUNDBLAD
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 1:11145 ABACO ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7729
Mailing Address - Country:US
Mailing Address - Phone:561-345-9197
Mailing Address - Fax:
Practice Address - Street 1:4016 SUN CITY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5298
Practice Address - Country:US
Practice Address - Phone:813-634-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS485941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS48594OtherFLORIDA BOARD OF PHARMACY