Provider Demographics
NPI:1467812354
Name:ANDERSON, LINNEA
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 W KENNEWICK AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2825 W KENNEWICK AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2927
Practice Address - Country:US
Practice Address - Phone:509-783-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60592867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist