Individual
DESTINY LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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
0010394
OR
Other
Enumeration date
08/01/2012
Last updated
08/01/2012
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