Individual
KYLE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
5717 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-2062
Mailing address
5717 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-2062
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0014361
OR
183500000X
Pharmacist
60277645
WA
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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