Provider Demographics
NPI:1144729013
Name:HOTRUM, STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HOTRUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 7TH AVE SE APT 3
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5006
Mailing Address - Country:US
Mailing Address - Phone:208-220-6291
Mailing Address - Fax:
Practice Address - Street 1:444 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-1543
Practice Address - Country:US
Practice Address - Phone:503-838-1176
Practice Address - Fax:866-267-6597
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7392183500000X
OR14106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist