Individual
ADAM LESLIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
51670 HUNTINGTON RD, LA PINE, OR 97739-9626
(541) 536-5052
(541) 536-1488
Mailing address
51670 HUNTINGTON RD, PO BOX 1976, LA PINE, OR 97739-9626
(541) 536-5052
(541) 536-1488
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0012679
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0012679
STATE PHARMACIST LICENSE
OR
Enumeration date
04/10/2012
Last updated
04/10/2012
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