Healthcare Provider Details

I. General information

NPI: 1588919310
Provider Name (Legal Business Name): SETH DAVID STORBY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

IV. Provider business mailing address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-7526
  • Fax: 541-296-7616
Mailing address:
  • Phone: 541-296-7526
  • Fax: 541-296-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0012767
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: