Healthcare Provider Details

I. General information

NPI: 1457665077
Provider Name (Legal Business Name): ANDREW J SCHLICHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
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

4432 SE MAIN ST
PORTLAND OR
97215-2439
US

V. Phone/Fax

Practice location:
  • Phone: 971-233-1002
  • Fax:
Mailing address:
  • Phone: 320-761-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0012219
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: