Healthcare Provider Details

I. General information

NPI: 1669605309
Provider Name (Legal Business Name): JENNIFER P HUA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 SW ALLEN BLVD
BEAVERTON OR
97007-3600
US

IV. Provider business mailing address

20560 SW DOROTHY DR
ALOHA OR
97006-2147
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-2724
  • Fax:
Mailing address:
  • Phone: 503-433-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011387
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: