Provider Demographics
NPI:1871927319
Name:LINDSTROM, DANIEL HOLLAND (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HOLLAND
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 CRATER LAKE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1663
Mailing Address - Country:US
Mailing Address - Phone:541-826-4414
Mailing Address - Fax:541-416-8366
Practice Address - Street 1:7591 CRATER LAKE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1663
Practice Address - Country:US
Practice Address - Phone:541-826-4414
Practice Address - Fax:541-416-8366
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019953183500000X
OR0013792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist