Provider Demographics
NPI:1790657211
Name:PON, JUSTIN TAI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TAI
Last Name:PON
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 1:1736 N GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1808
Mailing Address - Country:US
Mailing Address - Phone:888-501-0233
Mailing Address - Fax:214-432-8922
Practice Address - Street 1:1736 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1808
Practice Address - Country:US
Practice Address - Phone:888-501-0233
Practice Address - Fax:214-432-8922
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist