MEDICARE: MS. LINDA DENISE WADDELL RPH

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	RP039924L	PA

General Provider Information

NPI Number	:	1932370830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA DENISE WADDELL RPH

Provider Business Mailing Address
First Line	:	3021 GRAYS FERRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2709
Country	:	US
Telephone Number	:	215-551-7284
Fax Number	:	215-468-5218

Provider Business Practice Location Address
First Line	:	3021 GRAYS FERRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2709
Country	:	US
Telephone Number	:	215-551-7284
Fax Number	:	215-468-5218

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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