Provider Demographics
NPI:1063847796
Name:POREMBA, VICKIEANN ROSENBUSCH (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICKIEANN
Middle Name:ROSENBUSCH
Last Name:POREMBA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 E MCANDREWS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5590
Mailing Address - Country:US
Mailing Address - Phone:541-732-7950
Mailing Address - Fax:
Practice Address - Street 1:1698 E MCANDREWS RD STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5590
Practice Address - Country:US
Practice Address - Phone:541-732-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60371567183500000X
ORRPH-00143101835P2201X
MI5302038967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist