Healthcare Provider Details

I. General information

NPI: 1346659703
Provider Name (Legal Business Name): ERVINA WINATA HUFF PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2014
Last Update Date: 08/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 SE OAK ST
MILWAUKIE OR
97222-6641
US

IV. Provider business mailing address

2042 OAK ST
WEST LINN OR
97068-3544
US

V. Phone/Fax

Practice location:
  • Phone: 971-238-1297
  • Fax:
Mailing address:
  • Phone: 503-369-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014185
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: