Provider Demographics
NPI:1902170723
Name:ACIDERA, LINDA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:ACIDERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5620
Mailing Address - Country:US
Mailing Address - Phone:541-754-5583
Mailing Address - Fax:541-754-5577
Practice Address - Street 1:777 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5620
Practice Address - Country:US
Practice Address - Phone:541-754-5583
Practice Address - Fax:541-754-5577
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist