Basic Information
Provider Information | |||||||||
NPI: | 1013673706 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEUHAUS | ||||||||
FirstName: | ALICIA | ||||||||
MiddleName: | JUNE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CPHT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOUGHTON | ||||||||
OtherFirstName: | ALICIA | ||||||||
OtherMiddleName: | JUNE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CPHT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2000 CASCADE DR | ||||||||
Address2: |   | ||||||||
City: | LEBANON | ||||||||
State: | OR | ||||||||
PostalCode: | 973553568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5412317888 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 530 NW 27TH ST | ||||||||
Address2: |   | ||||||||
City: | CORVALLIS | ||||||||
State: | OR | ||||||||
PostalCode: | 973305223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5417666835 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2021 | ||||||||
LastUpdateDate: | 11/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X |   |   | Y |   | Pharmacy Service Providers | Pharmacy Technician |   |
No ID Information.