Individual
JACOB TANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1940 SE 12TH AVE APT 9, PORTLAND, OR 97214-4779
(503) 231-1043
Mailing address
1940SE 12TH, NO. 9, PORTLAND, OR 97214
(503) 231-1043
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
6788
OR
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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