Individual
JESSICA MAE DIZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD, MHA, BCPS
Contact information
Practice address
315 SW 5TH AVE, PORTLAND, OR 97204-1703
(503) 416-3917
Mailing address
2717 SW 2ND AVE APT 1, PORTLAND, OR 97201-4769
(949) 939-8148
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0016037
OR
183500000X
Pharmacist
22590
IA
Other
Enumeration date
08/05/2015
Last updated
07/21/2022
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