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General NPI Number Information
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NPI Number | 1184762791
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Entity Type | Organization
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Legal Business Name | PAUL LINDERUD
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 N LAKE AVE
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City | CRANDON
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State | WI
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Zip | 54520-1386
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Country | US
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Telephone | 715-478-3313
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Fax | 715-478-2065
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Provider Business Mailing Address
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Address Line | 101 N LAKE AVE
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City | CRANDON
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State | WI
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Zip | 54520-1386
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Country | US
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Telephone | 715-478-3313
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Fax | 715-478-2065
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Authorized Official
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Title or Position | OWNER RPH
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Name | PAUL LINDERUD
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Credential | RPH
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Telephone | 715-478-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7364-042
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License Number State | WI
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