MEDICARE: LINNEA ANN PUTNAM PHARM.D.,MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	4078	SD
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	4078	SD
3	183500000X	Pharmacist	4078	SD
4	1835G0303X	Geriatric Pharmacist	4078	SD

General Provider Information

NPI Number	:	1578566014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINNEA ANN PUTNAM PHARM.D.,MBA

Provider Business Mailing Address
First Line	:	5729 TREELINE CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8836
Country	:	US
Telephone Number	:	605-342-4304
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-355-2392
Fax Number	:	605-355-2565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/25/2009

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