Provider Demographics
NPI:1649518226
Name:BLAND, LINDA M (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BLAND
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 1:171 VILLAGE AT GLYNN PL
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1989
Mailing Address - Country:US
Mailing Address - Phone:912-261-4734
Mailing Address - Fax:912-261-4735
Practice Address - Street 1:171 VILLAGE AT GLYNN PL
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1989
Practice Address - Country:US
Practice Address - Phone:912-261-4734
Practice Address - Fax:912-261-4735
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist