=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548609407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA DALE GOLDWYER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2013
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1156 HIGH ST
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95064-1077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-459-2360
-----------------------------------------------------
Fax | 831-459-3546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 244 SEGRI PL
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-345-4432
-----------------------------------------------------
Fax | 831-426-1755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH48350
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------