Provider Demographics
NPI:1831439587
Name:SELIN, KURT E
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:E
Last Name:SELIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19145 SW MURPHY CT
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-4469
Mailing Address - Country:US
Mailing Address - Phone:503-642-3523
Mailing Address - Fax:
Practice Address - Street 1:220 S SENECA RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2725
Practice Address - Country:US
Practice Address - Phone:542-344-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist