Individual
JAKE EVAN DITTRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY INTERN
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6835
Mailing address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PI-0012676
OR
Other
Enumeration date
05/14/2017
Last updated
05/14/2017
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