Provider Demographics
NPI:1063586279
Name:NADAL, LINDA MARIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIA
Last Name:NADAL
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 1:1580 SW 187TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6163
Mailing Address - Country:US
Mailing Address - Phone:954-483-0877
Mailing Address - Fax:305-558-6728
Practice Address - Street 1:15450 NW 77TH CT
Practice Address - Street 2:WINN DIXIE PHARMACY #262
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6728
Practice Address - Country:US
Practice Address - Phone:305-558-6071
Practice Address - Fax:305-558-6728
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050937Medicare ID - Type UnspecifiedWINN DIXIE PHARMACY #262