Individual
JEFFREY MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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) 253-3747
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PH00017370
WA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH-0013850
OR
Other
Enumeration date
09/13/2011
Last updated
12/31/2015
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