Individual
KINGSAVANH PAUL PHILAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
5316 E BURNSIDE ST APT 21, PORTLAND, OR 97215-1280
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0016139
OR
Other
Enumeration date
08/10/2018
Last updated
08/10/2018
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