Healthcare Provider Details

I. General information

NPI: 1831172626
Provider Name (Legal Business Name): LINDA R BOLLAND PHARMD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 E CARSON ST SUITE 104
CARSON CA
90745-2262
US

IV. Provider business mailing address

30 MAHLON AVE
GORHAM ME
04038-1821
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-9246
  • Fax:
Mailing address:
  • Phone: 207-661-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46999
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number46999
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number46999
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: