Individual
PETRUS OLIPHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(503) 228-4533
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0014244
OR
Other
Enumeration date
08/26/2014
Last updated
08/26/2014
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