Provider Demographics
NPI:1467938175
Name:CARLSON, LINDA ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 BROWNS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1240
Mailing Address - Country:US
Mailing Address - Phone:815-543-7256
Mailing Address - Fax:
Practice Address - Street 1:1810 HARLEM RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2674
Practice Address - Country:US
Practice Address - Phone:815-637-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist