Provider Demographics
NPI:1720339013
Name:UETRECHT, ROBERT LEE (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:UETRECHT
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 1:210 SW CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1958
Mailing Address - Country:US
Mailing Address - Phone:541-389-9117
Mailing Address - Fax:541-389-9145
Practice Address - Street 1:210 SW CENTURY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1958
Practice Address - Country:US
Practice Address - Phone:541-389-9117
Practice Address - Fax:541-389-9145
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist