Provider Demographics
NPI:1962719138
Name:ANDERSEN, DAVID ARTHUR (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARTHUR
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 W POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5050
Mailing Address - Country:US
Mailing Address - Phone:503-492-2922
Mailing Address - Fax:503-492-8060
Practice Address - Street 1:4285 W POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5050
Practice Address - Country:US
Practice Address - Phone:503-492-2922
Practice Address - Fax:503-492-8060
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00007363183500000X
ORRPH-0004828183500000X
CARPH 26652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist