Healthcare Provider Details

I. General information

NPI: 1588588560
Provider Name (Legal Business Name): MS. VICTORIA MARIE BREMONT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS VICTORIA MARIE REBHOLZ

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MAIN ST APT 50
FOREST GROVE OR
97116-2363
US

IV. Provider business mailing address

2701 MAIN ST APT 50
FOREST GROVE OR
97116-2363
US

V. Phone/Fax

Practice location:
  • Phone: 702-419-6703
  • Fax:
Mailing address:
  • Phone: 702-419-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPI-0014720
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: