Individual
MISS AVALYN CAPISTRANO ROSALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
11930 SE DIVISION ST, PORTLAND, OR 97266-1037
(503) 761-6640
(503) 760-9219
Mailing address
11930 SE DIVISION ST, PORTLAND, OR 97266-1037
(503) 761-6640
(503) 760-9219
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0010570
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0010570
PHARMACY LICENSE
OR
Enumeration date
04/29/2011
Last updated
04/29/2011
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