Provider Demographics
NPI:1003464132
Name:LINTON SQUARE PHARMACY NORTH, LLC.
Entity Type:Organization
Organization Name:LINTON SQUARE PHARMACY NORTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:561-302-0045
Mailing Address - Street 1:2580 METROCENTRE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3100
Mailing Address - Country:US
Mailing Address - Phone:561-302-0045
Mailing Address - Fax:561-508-6938
Practice Address - Street 1:2580 METROCENTRE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3100
Practice Address - Country:US
Practice Address - Phone:561-302-0045
Practice Address - Fax:561-508-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32293OtherFLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE