Individual
AIDA WIJAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8330 N IVANHOE ST, PORTLAND, OR 97203-4824
(503) 205-1600
Mailing address
8330 N IVANHOE ST, PORTLAND, OR 97203-4824
(503) 205-1600
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0010283
OR
Other
Enumeration date
03/01/2011
Last updated
03/01/2011
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