Healthcare Provider Details

I. General information

NPI: 1073915237
Provider Name (Legal Business Name): INHKUONG LOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SW 72ND AVE
PORTLAND OR
97224-7745
US

IV. Provider business mailing address

16100 SW 72ND AVE
PORTLAND OR
97224-7745
US

V. Phone/Fax

Practice location:
  • Phone: 503-626-4936
  • Fax: 503-372-1792
Mailing address:
  • Phone: 503-626-4936
  • Fax: 503-372-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014265
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH-0014265
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: