Healthcare Provider Details

I. General information

NPI: 1609182997
Provider Name (Legal Business Name): ERIC RIMKUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25699 SE STARK ST
TROUTDALE OR
97060-3305
US

IV. Provider business mailing address

25699 SE STARK ST
TROUTDALE OR
97060-3305
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-9766
  • Fax: 503-665-9337
Mailing address:
  • Phone: 503-665-9766
  • Fax: 503-665-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8765
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: