Provider Demographics
NPI:1952649634
Name:WITZAL, LINDA M (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:WITZAL
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 1:379 DOVER CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3910
Mailing Address - Country:US
Mailing Address - Phone:862-324-4807
Mailing Address - Fax:973-584-6671
Practice Address - Street 1:379 DOVER CHESTER RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3910
Practice Address - Country:US
Practice Address - Phone:862-324-4807
Practice Address - Fax:973-584-6671
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1800700183500000X
MD20575183500000X
DEA1-0004167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist