Provider Demographics
NPI:1679179618
Name:LINN, GEORGE STEPHEN (PD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:STEPHEN
Last Name:LINN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3452
Mailing Address - Country:US
Mailing Address - Phone:501-208-1871
Mailing Address - Fax:
Practice Address - Street 1:1945 BUTTERFIELD COACH RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7320
Practice Address - Country:US
Practice Address - Phone:479-927-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist