Individual
WIEBKE GERLACH-JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
939 SW MORRISON ST, PORTLAND, OR 97205-2727
(503) 290-5362
Mailing address
7400 SW BARNES RD APT 442, PORTLAND, OR 97225-7015
(570) 362-9005
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
9109533
UT
183500000X
Pharmacist
Primary
RPH-0016598
OR
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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