Healthcare Provider Details

I. General information

NPI: 1013299916
Provider Name (Legal Business Name): KENNETH LINDGREN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2644
US

IV. Provider business mailing address

3053 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2644
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-0105
  • Fax: 772-288-5063
Mailing address:
  • Phone: 772-288-0105
  • Fax: 772-288-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS18139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: