Provider Demographics
NPI:1164716445
Name:LINDSTROM, BRAD H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:H
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2409
Mailing Address - Country:US
Mailing Address - Phone:760-256-8012
Mailing Address - Fax:760-256-8325
Practice Address - Street 1:1270 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2409
Practice Address - Country:US
Practice Address - Phone:760-256-8012
Practice Address - Fax:760-256-8325
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist