Individual
MANORAK CHANTHAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5717 NE 138TH AVE, PORTLAND, OR 97230-3499
(503) 261-7547
Mailing address
5717 NE 138TH AVE, PORTLAND, OR 97230-3499
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9171
OR
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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