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NPI Code Detail

MEDICARE: LEANNE LIJEN LIN R.PH

MEDICARE: LEANNE LIJEN LIN R.PH
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
1183500000XPharmacist5302030752MI

General Provider Information

NPI Number : 1548240062
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNE LIJEN LIN R.PH
Provider Business Mailing Address
First Line : 4325 BRETON RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3859
Country : US
Telephone Number : 616-281-5442
Fax Number : 616-281-6931
Provider Business Practice Location Address
First Line : 4325 BRETON RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3820
Country : US
Telephone Number : 616-281-5442
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 10/11/2011

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