Healthcare Provider Details

I. General information

NPI: 1033416573
Provider Name (Legal Business Name): DAVID ALAN PROUJAN R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 NE HIGHWAY 99
VANCOUVER WA
98665-8923
US

IV. Provider business mailing address

6708 NE 53RD PL
VANCOUVER WA
98661-1581
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-2207
  • Fax: 360-571-5480
Mailing address:
  • Phone: 843-817-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10378
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0014156
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: