Healthcare Provider Details

I. General information

NPI: 1144729013
Provider Name (Legal Business Name): STEPHEN HOTRUM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 PACIFIC AVE S
MONMOUTH OR
97361-1543
US

IV. Provider business mailing address

2734 7TH AVE SE APT 3
ALBANY OR
97322-5006
US

V. Phone/Fax

Practice location:
  • Phone: 503-838-1176
  • Fax: 866-267-6597
Mailing address:
  • Phone: 208-220-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7392
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14106
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: