Healthcare Provider Details

I. General information

NPI: 1831444371
Provider Name (Legal Business Name): ROBERT W ULRICH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E METHOW HWY BOX 37
TWISP WA
98856
US

IV. Provider business mailing address

PO BOX 37
TWISP WA
98856-0037
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00007574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: