MEDICARE: LINDA M WITZAL 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	1800700	NJ
2	183500000X	Pharmacist	20575	MD
3	183500000X	Pharmacist	A1-0004167	DE

General Provider Information

NPI Number	:	1952649634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M WITZAL RPH

Provider Business Mailing Address
First Line	:	379 DOVER CHESTER RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-3910
Country	:	US
Telephone Number	:	862-324-4807
Fax Number	:	973-584-6671

Provider Business Practice Location Address
First Line	:	379 DOVER CHESTER RD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-3910
Country	:	US
Telephone Number	:	862-324-4807
Fax Number	:	973-584-6671

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

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	06/12/2021

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