Healthcare Provider Details

I. General information

NPI: 1760755409
Provider Name (Legal Business Name): MARTHA ALEXIS KUHN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 MOHAWK BLVD
SPRINGFIELD OR
97477-3355
US

IV. Provider business mailing address

1521 MOHAWK BLVD
SPRINGFIELD OR
97477-3355
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7633
  • Fax: 541-741-0715
Mailing address:
  • Phone: 541-687-7633
  • Fax: 541-741-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-010811
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: