Healthcare Provider Details

I. General information

NPI: 1730742271
Provider Name (Legal Business Name): JASON PATTERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD # P2PHAR
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

3155 SW MOODY AVE APT 417
PORTLAND OR
97239-4732
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 503-721-1481
Mailing address:
  • Phone: 913-725-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-106047
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: