Provider Demographics
NPI:1548240062
Name:LIN, LEANNE LIJEN (RPH)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:LIJEN
Last Name:LIN
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 1:4325 BRETON RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3859
Mailing Address - Country:US
Mailing Address - Phone:616-281-5442
Mailing Address - Fax:616-281-6931
Practice Address - Street 1:4325 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3820
Practice Address - Country:US
Practice Address - Phone:616-281-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist