MEDICARE: DR. DANIEL HOLLAND LINDSTROM PHARM D.

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	S019953	AZ
2	183500000X	Pharmacist	0013792	OR

General Provider Information

NPI Number	:	1871927319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL HOLLAND LINDSTROM PHARM D.

Provider Business Mailing Address
First Line	:	7591 CRATER LAKE HWY
Second Line	:	SUITE A
City	:	WHITE CITY
State	:	OR
Zip	:	97503-1663
Country	:	US
Telephone Number	:	541-826-4414
Fax Number	:	541-416-8366

Provider Business Practice Location Address
First Line	:	7591 CRATER LAKE HWY
Second Line	:	SUITE A
City	:	WHITE CITY
State	:	OR
Zip	:	97503-1663
Country	:	US
Telephone Number	:	541-826-4414
Fax Number	:	541-416-8366

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

Provider Enumeration Date	:	09/01/2013
Last Update Date	:	09/23/2015

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