Provider Demographics
NPI:1417101874
Name:BRANKOVIC, AMELA (RPA RPH)
Entity Type:Individual
Prefix:MS
First Name:AMELA
Middle Name:
Last Name:BRANKOVIC
Suffix:
Gender:F
Credentials:RPA RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 N. LOMBARD ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217
Mailing Address - Country:US
Mailing Address - Phone:503-737-0317
Mailing Address - Fax:503-737-0324
Practice Address - Street 1:2829 N. LOMBARD ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-737-0317
Practice Address - Fax:503-737-0324
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPM-0010122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist