MEDICARE: LINARIA KITCHEN

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	RPH-0017356	OR

General Provider Information

NPI Number	:	1134762925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINARIA KITCHEN

Provider Business Mailing Address
First Line	:	1310 N MOUNTAIN AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-9392
Country	:	US
Telephone Number	:	541-778-8065
Fax Number	:

Provider Business Practice Location Address
First Line	:	7591 CRATER LAKE HWY # A
Second Line	:
City	:	WHITE CITY
State	:	OR
Zip	:	97503-1663
Country	:	US
Telephone Number	:	541-826-4414
Fax Number	:

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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Directions to “ LINARIA KITCHEN ” Practice Location

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