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Individual

MR. SCOTT WALLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
5717 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-7541
Mailing address
8155 SW BIRCHWOOD RD, PORTLAND, OR 97225-2737
(503) 261-7541

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9033
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
9033
OR

Other

Enumeration date
07/06/2016
Last updated
07/06/2016
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