MEDICARE: JAMES NOEUN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0016015	OR

General Provider Information

NPI Number	:	1639694243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES NOEUN PHARM D

Provider Business Mailing Address
First Line	:	222 SW HARRISON ST APT 7H
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19133 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2019
Country	:	US
Telephone Number	:	503-303-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	08/21/2017

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