Provider Demographics
NPI:1659652584
Name:ASTA, LINDA (RPH PHARMD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ASTA
Suffix:
Gender:F
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 OLD CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7758
Mailing Address - Country:US
Mailing Address - Phone:630-985-9310
Mailing Address - Fax:
Practice Address - Street 1:1198 OLD CREEK CT
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7758
Practice Address - Country:US
Practice Address - Phone:630-985-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist