Healthcare Provider Details

I. General information

NPI: 1265725675
Provider Name (Legal Business Name): VESNA PUZIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 SW WALKER RD
BEAVERTON OR
97005-1306
US

IV. Provider business mailing address

772 NW 118TH AVE UNIT 101
PORTLAND OR
97229-5966
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-2423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011109
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: