Individual
MRS. TRACY L FENTRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
9775 SW GEMINI DR, BEAVERTON, OR 97008-7148
(888) 202-4014
Mailing address
9775 SW GEMINI DR, BEAVERTON, OR 97008-7148
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
8796
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
8796
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12341
NOT SURE
—
01
—
NA
NA
—
Enumeration date
09/02/2009
Last updated
06/24/2020
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