Provider Demographics
NPI:1629344718
Name:FOX, LINDA BRADFORD (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BRADFORD
Last Name:FOX
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 1:1875 FANT DR.
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHOPRE
Mailing Address - State:GA
Mailing Address - Zip Code:30742
Mailing Address - Country:US
Mailing Address - Phone:706-861-3387
Mailing Address - Fax:
Practice Address - Street 1:1875 FANT DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3307
Practice Address - Country:US
Practice Address - Phone:706-861-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist