Provider Demographics
NPI:1265777999
Name:LUNDBERG, LINDA JOYCE (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOYCE
Other - Last Name:LONGTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11134N HWY 77
Mailing Address - Street 2:ESSENTIA HEALTH HAYWARD PHARMACY
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-5325
Mailing Address - Country:US
Mailing Address - Phone:715-634-6774
Mailing Address - Fax:715-634-5517
Practice Address - Street 1:11134N HWY 77
Practice Address - Street 2:ESSENTIA HEALTH HAYWARD PHARMACY
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5325
Practice Address - Country:US
Practice Address - Phone:715-634-6774
Practice Address - Fax:715-634-5517
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1901-0295-4878-756183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician