Individual
ANDREW VANDERWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1357 MONMOUTH ST, INDEPENDENCE, OR 97351-1126
(503) 838-2195
(503) 838-3129
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-0014885
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
RPH-0014885
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0014885
OREGON RPH LICENSE
OR
Enumeration date
09/09/2015
Last updated
01/05/2016
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