Provider Demographics
NPI:1801180856
Name:LINEDECKER, RICK
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:LINEDECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 N MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7939
Mailing Address - Country:US
Mailing Address - Phone:317-876-0921
Mailing Address - Fax:317-876-0921
Practice Address - Street 1:10401 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7939
Practice Address - Country:US
Practice Address - Phone:317-876-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017620A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist