Individual
MS. MARYLOU WACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4849 NE 138TH AVE, PORTLAND, OR 97230-3401
(503) 257-3935
(503) 253-3747
Mailing address
4849 NE 138TH AVE, PORTLAND, OR 97230-3401
(503) 257-3935
(503) 257-3935
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
4981
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
4981
OR
Other
Enumeration date
05/08/2012
Last updated
12/31/2015
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