Individual
PHUC LA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
6116 NE MARTIN LUTHER KING JR, PORTLAND, OR 97211-3159
(503) 282-0689
(503) 282-0809
Mailing address
6116 NE MARTIN LUTHER KING JR, PORTLAND, OR 97211-3159
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0011210
OR
Other
Enumeration date
11/18/2008
Last updated
11/18/2008
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