Provider Demographics
NPI:1295049567
Name:BANARES, LINDA WYLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:WYLIE
Last Name:BANARES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 JOHNSON LN
Mailing Address - Street 2:TOURO UNIVERSITY COLLEGE OF PHARMACY
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1159
Mailing Address - Country:US
Mailing Address - Phone:707-638-5950
Mailing Address - Fax:707-638-5959
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:GENERAL MEDICINE CLINIC, 1M-3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8978
Practice Address - Fax:415-206-5857
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA639621835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist