Healthcare Provider Details

I. General information

NPI: 1366931560
Provider Name (Legal Business Name): DUSTIN LINN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

10627 DIEBOLD RD
FORT WAYNE IN
46845-8606
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-1000
  • Fax:
Mailing address:
  • Phone: 260-470-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number26022726A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: