Individual
TINA MARIE GANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
514 NE 181ST AVE, PORTLAND, OR 97230-6702
(503) 661-6991
(503) 661-0615
Mailing address
514 NE 181ST AVE, PORTLAND, OR 97230-6702
(503) 661-6991
(503) 661-0615
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT0009907
OR
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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