Provider Demographics
NPI:1518381813
Name:LINDAU, GARY D I (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:LINDAU
Suffix:I
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 1:145 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1475
Mailing Address - Country:US
Mailing Address - Phone:419-878-8472
Mailing Address - Fax:
Practice Address - Street 1:145 WATER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1475
Practice Address - Country:US
Practice Address - Phone:419-878-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03112379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist