Provider Demographics
NPI:1851752398
Name:LINDSTROM, DEBORAH KATHRYNE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHRYNE
Last Name:LINDSTROM
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 1:457 JESSEN LN STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7987
Mailing Address - Country:US
Mailing Address - Phone:843-971-5492
Mailing Address - Fax:
Practice Address - Street 1:457 JESSEN LN STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7987
Practice Address - Country:US
Practice Address - Phone:843-971-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist