Provider Demographics
NPI:1710589197
Name:RHODES, LINDA MICHELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MICHELE
Last Name:RHODES
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 1:1980 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7608
Mailing Address - Country:US
Mailing Address - Phone:573-631-6168
Mailing Address - Fax:
Practice Address - Street 1:611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1111
Practice Address - Country:US
Practice Address - Phone:573-783-3341
Practice Address - Fax:573-783-1063
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist