Healthcare Provider Details

I. General information

NPI: 1225338940
Provider Name (Legal Business Name): CHRISTINE ANN ULRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E. METHOW HWY
TWISP WA
98856
US

IV. Provider business mailing address

PO BOX 37
TWISP WA
98856
US

V. Phone/Fax

Practice location:
  • Phone: 509-997-2191
  • Fax: 509-997-9205
Mailing address:
  • Phone: 509-997-2191
  • Fax: 509-997-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: