MEDICARE: HENDRIK VAN DER LINDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	54364	CA

General Provider Information

NPI Number	:	1083028682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENDRIK VAN DER LINDE

Provider Business Mailing Address
First Line	:	72875 HIGHWAY 111
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3312
Country	:	US
Telephone Number	:	760-346-2618
Fax Number	:	760-773-0228

Provider Business Practice Location Address
First Line	:	72875 HIGHWAY 111
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3312
Country	:	US
Telephone Number	:	760-346-2618
Fax Number	:	760-773-0228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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Directions to “ HENDRIK VAN DER LINDE ” Practice Location

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