Basic Information
| Provider Information | |||||||||
| NPI: | 1215593355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ULRICH | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6149 | ||||||||
| Address2: | |||||||||
| City: | ALOHA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970070149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033528657 | ||||||||
| FaxNumber: | 5034348597 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 SW CEDAR HILLS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970051435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033526000 | ||||||||
| FaxNumber: | 5033526080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2019 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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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 | 183500000X | RPH-0016754 | OR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.