Provider Demographics
NPI:1346389830
Name:PAUL LINDERUD
Entity Type:Organization
Organization Name:PAUL LINDERUD
Other - Org Name:LAONA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERRPH
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDERUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:715-674-2635
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LAONA
Mailing Address - State:WI
Mailing Address - Zip Code:54541-0008
Mailing Address - Country:US
Mailing Address - Phone:715-674-2635
Mailing Address - Fax:715-674-4603
Practice Address - Street 1:4876 MILL ST.
Practice Address - Street 2:
Practice Address - City:LAONA
Practice Address - State:WI
Practice Address - Zip Code:54541
Practice Address - Country:US
Practice Address - Phone:715-674-2635
Practice Address - Fax:715-674-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7555-042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33212300Medicaid
WI5116745OtherNABP#