Individual
TARA MICHELLE WICHTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1804 COLUMBIA BLVD, SAINT HELENS, OR 97051-1733
(503) 397-5555
(503) 397-5441
Mailing address
916 W EVERGREEN BLVD, VANCOUVER, WA 98660-3035
(360) 213-2236
(360) 213-2238
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0014232
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0014232
RPH LICENSE
—
Enumeration date
08/07/2014
Last updated
08/07/2014
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