Individual
BAO LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6348 NE HALSEY ST STE A, PORTLAND, OR 97213-4720
(503) 962-1700
Mailing address
15570 SW PACIFIC HWY, TIGARD, OR 97224-3522
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0013108
OR
Other
Enumeration date
08/22/2012
Last updated
05/21/2019
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