Individual
JENNIFER DATTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
342 E THIRD ST., BEND, OR 97701
(541) 312-6486
(541) 312-6488
Mailing address
342 E THIRD ST., BEND, OR 97701
(541) 312-6486
(541) 312-6488
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP-00001016-CS
OR
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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