Provider Demographics
NPI:1205194131
Name:CONTRERAS, ADRIAN ALEJANDRO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:ALEJANDRO
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ADRIAN
Other - Middle Name:ALEJANDRO
Other - Last Name:CONTRERAS CONKLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1600 MOUNT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9071
Mailing Address - Country:US
Mailing Address - Phone:503-981-2106
Mailing Address - Fax:503-981-2106
Practice Address - Street 1:1600 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9071
Practice Address - Country:US
Practice Address - Phone:503-981-2106
Practice Address - Fax:503-981-2106
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11249183500000X
WA60154448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11249OtherSTATE PHARMACIST LICENSE
WA60154448OtherSTATE PHARMACIST LICENSE