Provider Demographics
NPI:1023642162
Name:VANDER LINDEN, BRYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:VANDER LINDEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 KODI CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3756
Mailing Address - Country:US
Mailing Address - Phone:641-204-1312
Mailing Address - Fax:
Practice Address - Street 1:300 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3241
Practice Address - Country:US
Practice Address - Phone:641-472-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist