Healthcare Provider Details

I. General information

NPI: 1578566014
Provider Name (Legal Business Name): LINNEA ANN PUTNAM PHARM.D.,MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 07/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CANYON LAKE DR
RAPID CITY SD
57702-8114
US

IV. Provider business mailing address

5729 TREELINE CT
RAPID CITY SD
57702-8836
US

V. Phone/Fax

Practice location:
  • Phone: 605-355-2392
  • Fax: 605-355-2565
Mailing address:
  • Phone: 605-342-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4078
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4078
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number4078
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number4078
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: