1790794428 NPI number — DR. LINDA BLACK SHUMAKER PHARMD

Table of content: DR. LINDA BLACK SHUMAKER PHARMD (NPI 1790794428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790794428 NPI number — DR. LINDA BLACK SHUMAKER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMAKER
Provider First Name:
LINDA
Provider Middle Name:
BLACK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790794428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16881 E 2705 NORTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61834-6060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-759-7829
Provider Business Mailing Address Fax Number:
217-759-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 E MAIN ST
Provider Second Line Business Practice Location Address:
119
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-554-4239
Provider Business Practice Location Address Fax Number:
217-554-4808
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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