Provider Demographics
NPI:1619292711
Name:STUMPER, LINDA ELLEN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:ELLEN
Last Name:STUMPER
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 1:450 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1518
Mailing Address - Country:US
Mailing Address - Phone:201-288-0404
Mailing Address - Fax:201-393-0859
Practice Address - Street 1:450 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1518
Practice Address - Country:US
Practice Address - Phone:201-288-0404
Practice Address - Fax:201-393-0859
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01802900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist