Provider Demographics
NPI:1093005142
Name:LOETELL, LINDA (RPH; CPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LOETELL
Suffix:
Gender:F
Credentials:RPH; CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3540
Mailing Address - Country:US
Mailing Address - Phone:813-254-8303
Mailing Address - Fax:
Practice Address - Street 1:128 W DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3540
Practice Address - Country:US
Practice Address - Phone:813-254-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL206241835P0018X
FL44881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist