Provider Demographics
NPI:1316966484
Name:EPPIK INC
Entity type:Organization
Organization Name:EPPIK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-538-5715
Mailing Address - Street 1:201 VILLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1828
Mailing Address - Country:US
Mailing Address - Phone:503-538-5715
Mailing Address - Fax:503-537-1068
Practice Address - Street 1:201 VILLA RD STE A
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1828
Practice Address - Country:US
Practice Address - Phone:503-538-5715
Practice Address - Fax:503-537-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIP0002152CS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079449OtherPK