Provider Demographics
NPI:1821859646
Name:LINDER, ELKANAH
Entity Type:Individual
Prefix:
First Name:ELKANAH
Middle Name:
Last Name:LINDER
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 1:282 BERLIN MALL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8493
Mailing Address - Country:US
Mailing Address - Phone:022-299-8049
Mailing Address - Fax:
Practice Address - Street 1:282 BERLIN MALL RD STE 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8493
Practice Address - Country:US
Practice Address - Phone:802-229-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0135131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist