Individual
WINONA-REBEKAH BLANCO MARATITA-LIZAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8122 SE TIBBETTS ST, PORTLAND, OR 97206-1768
(503) 777-7055
Mailing address
1815 4TH ST, TILLAMOOK, OR 97141-2210
(503) 842-5934
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0017811
OR
Other
Enumeration date
06/01/2020
Last updated
03/16/2024
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