1871734202 NPI number — DR. ANNA LEE EMOTO PHARM.D.

Table of content: DR. ANNA LEE EMOTO PHARM.D. (NPI 1871734202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871734202 NPI number — DR. ANNA LEE EMOTO PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMOTO
Provider First Name:
ANNA
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORN
Provider Other First Name:
ANNA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871734202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 SW ALLEN CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97527-5559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-471-9043
Provider Business Mailing Address Fax Number:
541-471-9047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 SW ALLEN CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97527-5559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-471-9043
Provider Business Practice Location Address Fax Number:
541-471-9047
Provider Enumeration Date:
03/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  RPH-0010967 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RPH-0010967 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 40601 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)