Provider Demographics
NPI:1275833675
Name:DO, DA-ANH (BS)
Entity Type:Individual
Prefix:
First Name:DA-ANH
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 QUAIL HOLLOW ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-8592
Mailing Address - Country:US
Mailing Address - Phone:503-375-7659
Mailing Address - Fax:
Practice Address - Street 1:5660 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1215
Practice Address - Country:US
Practice Address - Phone:503-364-1520
Practice Address - Fax:503-391-9302
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8657183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist