Provider Demographics
NPI:1104158344
Name:BOLLER, LINDA
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:BOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225-2112
Mailing Address - Country:US
Mailing Address - Phone:317-784-6831
Mailing Address - Fax:317-783-6043
Practice Address - Street 1:2715 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-2112
Practice Address - Country:US
Practice Address - Phone:317-784-6831
Practice Address - Fax:317-783-6043
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017689A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist