Provider Demographics
NPI:1003448184
Name:LINCO PHARMACY, INC.
Entity Type:Organization
Organization Name:LINCO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:323-864-8700
Mailing Address - Street 1:5755 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2440
Mailing Address - Country:US
Mailing Address - Phone:323-879-9875
Mailing Address - Fax:323-879-9876
Practice Address - Street 1:5755 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2440
Practice Address - Country:US
Practice Address - Phone:323-879-9875
Practice Address - Fax:323-879-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy