Provider Demographics
NPI:1225170921
Name:VANDER LINDEN, THOMAS BERNARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BERNARD
Last Name:VANDER LINDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1223
Mailing Address - Country:US
Mailing Address - Phone:641-628-9313
Mailing Address - Fax:
Practice Address - Street 1:118 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-2200
Practice Address - Country:US
Practice Address - Phone:641-628-1280
Practice Address - Fax:641-628-3626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist