Provider Demographics
NPI:1265936058
Name:BULOCHNIK SHTEYNBERG, ALEXANDER (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BULOCHNIK SHTEYNBERG
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:BULOCHNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2815 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2590
Mailing Address - Country:US
Mailing Address - Phone:515-779-4088
Mailing Address - Fax:
Practice Address - Street 1:800 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1999
Practice Address - Country:US
Practice Address - Phone:503-221-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00125591835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care