Provider Demographics
NPI:1568795656
Name:ANDERSON, JAMES DWIGHT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DWIGHT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SE GOODFELLOW ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-3016
Mailing Address - Country:US
Mailing Address - Phone:541-889-6288
Mailing Address - Fax:541-889-5675
Practice Address - Street 1:65 SE GOODFELLOW ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3016
Practice Address - Country:US
Practice Address - Phone:541-889-6288
Practice Address - Fax:541-889-5675
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist