Provider Demographics
NPI:1003229824
Name:LIN, CLIVE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SAND CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7058
Mailing Address - Country:US
Mailing Address - Phone:925-513-8844
Mailing Address - Fax:
Practice Address - Street 1:2400 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7058
Practice Address - Country:US
Practice Address - Phone:925-513-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist