Individual
KENT NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14700 SE DIVISION ST, PORTLAND, OR 97236-2335
(503) 762-4436
Mailing address
15336 SE OGDEN DR, PORTLAND, OR 97236-7859
(503) 762-0623
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9757
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
9757
OR
Other
Enumeration date
01/11/2013
Last updated
04/26/2017
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