Individual
JAN HAXBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
(503) 494-2098
Mailing address
2942 SW ARNOLD ST, PORTLAND, OR 97219-7534
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH0007582
OR
Other
Enumeration date
11/19/2015
Last updated
11/19/2015
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