Healthcare Provider Details

I. General information

NPI: 1215201223
Provider Name (Legal Business Name): JAY P FLESCH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S CHILOQUIN BLVD
CHILOQUIN OR
97624-6747
US

IV. Provider business mailing address

PO BOX 3999
SUNRIVER OR
97707-3999
US

V. Phone/Fax

Practice location:
  • Phone: 541-783-3551
  • Fax: 541-783-3554
Mailing address:
  • Phone: 541-771-7457
  • Fax: 541-783-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9661
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: