Provider Demographics
NPI:1659644516
Name:MOHLER, ANDREW T (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:MOHLER
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:PO BOX 2342
Mailing Address - Street 2:445 W. HWY 20
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759
Mailing Address - Country:US
Mailing Address - Phone:541-719-2003
Mailing Address - Fax:
Practice Address - Street 1:445 W HWY 20
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759
Practice Address - Country:US
Practice Address - Phone:541-719-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7390OtherSTATE PHARMACIST LICENSE