Healthcare Provider Details

I. General information

NPI: 1295009157
Provider Name (Legal Business Name): SOCHEAT SAO PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 N INTERSTATE
PORTLAND OR
97217
US

IV. Provider business mailing address

7513 SW CAPITOL HWY
PORTLAND OR
97219-2434
US

V. Phone/Fax

Practice location:
  • Phone: 503-286-6784
  • Fax:
Mailing address:
  • Phone: 503-568-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0012711
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0012711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: