Healthcare Provider Details

I. General information

NPI: 1720498371
Provider Name (Legal Business Name): NICOLE JEANE O'KANE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SW GEMINI DR STE 1
BEAVERTON OR
97008-7148
US

IV. Provider business mailing address

9775 SW GEMINI DR STE 1
BEAVERTON OR
97008-7148
US

V. Phone/Fax

Practice location:
  • Phone: 866-202-4014
  • Fax: 866-579-4546
Mailing address:
  • Phone: 866-202-4014
  • Fax: 866-579-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9508
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: