Individual
DERK PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
401 S ROOSEVELT, SEASIDE, OR 97138
(503) 738-4706
Mailing address
PO BOX 1177, SEASIDE, OR 97138
(801) 842-3607
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013656
OR
183500000X
Pharmacist
120777
MN
183500000X
Pharmacist
2079
AK
Other
Enumeration date
08/27/2013
Last updated
08/27/2013
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