MEDICARE: MANDY N AMBROZ CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	CPT-0007835	OR

General Provider Information

NPI Number	:	1528648433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY N AMBROZ CPHT

Provider Business Mailing Address
First Line	:	11930 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1037
Country	:	US
Telephone Number	:	503-761-6640
Fax Number	:	503-760-9219

Provider Business Practice Location Address
First Line	:	11930 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1037
Country	:	US
Telephone Number	:	503-761-6640
Fax Number	:	503-760-9219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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