Provider Demographics
NPI:1508901299
Name:LINDGREN, MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LINDGREN
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 1:4115 N WINNIFRED
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407
Mailing Address - Country:US
Mailing Address - Phone:253-759-3525
Mailing Address - Fax:
Practice Address - Street 1:2901 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4614
Practice Address - Country:US
Practice Address - Phone:253-534-7011
Practice Address - Fax:253-534-7012
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist