Individual
MARY WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
3800 SE 22ND AVE, 04004/RDS, PORTLAND, OR 97202-2918
(503) 797-5082
Mailing address
19605 NE 130TH CIR, BRUSH PRAIRIE, WA 98606-3904
(360) 901-2842
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013605
OR
Other
Enumeration date
08/08/2013
Last updated
09/17/2015
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