Individual
JESSICA GANSCHOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
1415 SW 11TH AVE, #6, PORTLAND, OR 97201-3372
(208) 695-0750
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7352
ID
Other
Enumeration date
05/15/2015
Last updated
08/12/2015
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