Basic Information
| Provider Information | |||||||||
| NPI: | 1043228570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMUELS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38515 PIT RD | ||||||||
| Address2: | |||||||||
| City: | PHILOMATH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973709771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419294222 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 PLAGEMAN BLDG | ||||||||
| Address2: | OSU PHARMACY | ||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417373491 | ||||||||
| FaxNumber: | 5417377616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5812 | OR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.