Provider Demographics
NPI:1194313916
Name:MATHERS, LINDA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MATHERS
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 1:2463 SOPHIA CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1496
Mailing Address - Country:US
Mailing Address - Phone:410-241-0361
Mailing Address - Fax:410-534-0143
Practice Address - Street 1:3120 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1720
Practice Address - Country:US
Practice Address - Phone:443-703-3683
Practice Address - Fax:410-534-0143
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1073754461Medicaid