Healthcare Provider Details

I. General information

NPI: 1437875762
Provider Name (Legal Business Name): TIANA ENOS-DANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

308 S MONTGOMERY ST APT 406
PORTLAND OR
97201-5138
US

V. Phone/Fax

Practice location:
  • Phone: 808-783-3815
  • Fax:
Mailing address:
  • Phone: 808-783-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0019217
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: