Individual
KELLI ANN OMATSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
3527 SE 122ND AVE, PORTLAND, OR 97236-3401
(503) 760-6688
Mailing address
3527 SE 122ND AVE, PORTLAND, OR 97236-3401
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0021006
OR
Other
Enumeration date
05/04/2026
Last updated
05/04/2026
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