Provider Demographics
NPI:1134762925
Name:KITCHEN, LINARIA
Entity type:Individual
Prefix:
First Name:LINARIA
Middle Name:
Last Name:KITCHEN
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 1:1310 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9392
Mailing Address - Country:US
Mailing Address - Phone:541-778-8065
Mailing Address - Fax:
Practice Address - Street 1:7591 CRATER LAKE HWY # A
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1663
Practice Address - Country:US
Practice Address - Phone:541-826-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist