Provider Demographics
NPI:1548542475
Name:STAFFON, LINDA MAE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:MAE
Last Name:STAFFON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LAUREL WOOD WAY UNIT 205
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3115
Mailing Address - Country:US
Mailing Address - Phone:508-889-6068
Mailing Address - Fax:
Practice Address - Street 1:215 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8218
Practice Address - Country:US
Practice Address - Phone:386-986-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist