Provider Demographics
NPI:1922453893
Name:REYNOSO, LYNDON B (RPH)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:B
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7410
Mailing Address - Country:US
Mailing Address - Phone:303-222-4474
Mailing Address - Fax:303-222-4474
Practice Address - Street 1:5957 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80212-7410
Practice Address - Country:US
Practice Address - Phone:720-748-2449
Practice Address - Fax:303-222-4456
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist