Individual
JEFFREY A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
600 NW 10TH AVE, PORTLAND, OR 97209-3202
(503) 227-4835
Mailing address
16170 SE GOOSEHOLLOW DR, DAMASCUS, OR 97015-7885
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH0010544
OR
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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