Individual
JAKE KYLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH
Contact information
Practice address
1992 LANCASTER DR NE, SALEM, OR 97305-1021
(503) 362-4845
Mailing address
1992 LANCASTER DR NE, SALEM, OR 97305-1021
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0008411
OR
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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