Provider Demographics
NPI:1548609407
Name:GOLDWYER, LINDA DALE (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DALE
Last Name:GOLDWYER
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 1:244 SEGRI PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3137
Mailing Address - Country:US
Mailing Address - Phone:831-345-4432
Mailing Address - Fax:831-426-1755
Practice Address - Street 1:220 SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2161
Practice Address - Country:US
Practice Address - Phone:831-469-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH48350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist