Provider Demographics
NPI:1164709853
Name:LINDSTROM, MARY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469
Mailing Address - Country:US
Mailing Address - Phone:561-741-8530
Mailing Address - Fax:561-741-8663
Practice Address - Street 1:500 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2372
Practice Address - Country:US
Practice Address - Phone:561-741-8530
Practice Address - Fax:561-741-8663
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist