Provider Demographics
NPI:1780854133
Name:WEN, LINDA (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WEN
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 1:2095 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4247
Mailing Address - Country:US
Mailing Address - Phone:516-285-4214
Mailing Address - Fax:
Practice Address - Street 1:2095 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4247
Practice Address - Country:US
Practice Address - Phone:516-285-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048107183500000X
NY0048107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist