Healthcare Provider Details

I. General information

NPI: 1912830126
Provider Name (Legal Business Name): DAYANA JAALOUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SE EVELYN ST
CLACKAMAS OR
97015-9515
US

IV. Provider business mailing address

9701 SE JOHNSON CREEK BLVD APT O204
HAPPY VALLEY OR
97086-9621
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0021062
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: