Provider Demographics
NPI:1013078195
Name:LINDEN PHARMACY
Entity type:Organization
Organization Name:LINDEN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGNASCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:209-887-3397
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:CA
Mailing Address - Zip Code:95236
Mailing Address - Country:US
Mailing Address - Phone:209-887-3397
Mailing Address - Fax:
Practice Address - Street 1:19047 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:CA
Practice Address - Zip Code:95236-9492
Practice Address - Country:US
Practice Address - Phone:209-887-3397
Practice Address - Fax:209-887-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY32300Medicaid