Provider Demographics
NPI:1356665665
Name:GERTZ, LINDA LOU (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:GERTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:LOU
Other - Last Name:PULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:10015 BASCOM RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9193
Mailing Address - Country:US
Mailing Address - Phone:440-285-4983
Mailing Address - Fax:
Practice Address - Street 1:10015 BASCOM RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9193
Practice Address - Country:US
Practice Address - Phone:440-285-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03215161OtherPHARMACIST