Provider Demographics
NPI:1447536354
Name:MADDAUS-WHITE, LINDA JOANNE (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOANNE
Last Name:MADDAUS-WHITE
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 1:5121 VERNON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2104
Mailing Address - Country:US
Mailing Address - Phone:952-920-5899
Mailing Address - Fax:
Practice Address - Street 1:5121 VERNON AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2104
Practice Address - Country:US
Practice Address - Phone:952-920-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112288-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist