Basic Information
| Provider Information | |||||||||
| NPI: | 1033416573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROUJAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6708 NE 53RD PL | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986611581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438173607 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9000 NE HIGHWAY 99 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986658923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605712207 | ||||||||
| FaxNumber: | 3605715480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 0014156 | OR | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 183500000X | 10378 | SC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.