Healthcare Provider Details

I. General information

NPI: 1851664734
Provider Name (Legal Business Name): RONALD KUIPER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 NE 117TH AVE
VANCOUVER WA
98662-4706
US

IV. Provider business mailing address

7411 NE 117TH AVE
VANCOUVER WA
98662-4706
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-3533
  • Fax:
Mailing address:
  • Phone: 360-896-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00039274
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0008322
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: