Individual
MR. FRED P ISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
10254 SE TERRA LINDA CT, HAPPY VALLEY, OR 97086-6890
(503) 777-5679
Mailing address
10254 SE TERRA LINDA CT, HAPPY VALLEY, OR 97086-6890
(503) 449-3733
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
7241
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
7241
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7241
OREGON BOARD OF PHARMACY
OR
Enumeration date
11/19/2010
Last updated
01/10/2016
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