Healthcare Provider Details

I. General information

NPI: 1386255156
Provider Name (Legal Business Name): CRYSTAL JIHYUN RIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24988 SE STARK ST STE 220
GRESHAM OR
97030-8324
US

IV. Provider business mailing address

2270 NW SAVIER ST APT 417
PORTLAND OR
97210-3909
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-3064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0017422
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: