Provider Demographics
NPI:1730635624
Name:WATKINS, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 UNIVERSITY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:E PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:E PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1774
Practice Address - Country:US
Practice Address - Phone:650-321-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH273161835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184613051Medicare UPIN