Healthcare Provider Details

I. General information

NPI: 1891755799
Provider Name (Legal Business Name): STROHECKERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 SE HOLGATE BLVD SUITE C-1
PORTLAND OR
97202-5053
US

IV. Provider business mailing address

1286 SE HOLGATE BLVD SUITE C-1
PORTLAND OR
97202-5053
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-4822
  • Fax: 503-222-4868
Mailing address:
  • Phone: 503-222-4822
  • Fax: 503-222-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberRP-0000985-CS
License Number StateOR

VIII. Authorized Official

Name: RONALD DULWICK
Title or Position: PRESIDENT
Credential:
Phone: 503-720-9485