Healthcare Provider Details

I. General information

NPI: 1659686392
Provider Name (Legal Business Name): JASON ANTHONY SMITH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NE BURNSIDE RD
GRESHAM OR
97030-7949
US

IV. Provider business mailing address

501 N GRAHAM ST
PORTLAND OR
97227-1654
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-8482
  • Fax:
Mailing address:
  • Phone: 503-413-4225
  • Fax: 503-413-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0012293
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12293
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: