Healthcare Provider Details

I. General information

NPI: 1891101184
Provider Name (Legal Business Name): ALEKSANDAR TODOROVIC R.PH., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E OAK ST
LEBANON OR
97355-3222
US

IV. Provider business mailing address

777 NW KINGS BLVD
CORVALLIS OR
97330-5620
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014030
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH0014030
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: