Healthcare Provider Details

I. General information

NPI: 1013928563
Provider Name (Legal Business Name): ALLAN S. JIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

1903 SW VISTA PL
PENDLETON OR
97801-4236
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-276-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9980
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: