Healthcare Provider Details

I. General information

NPI: 1790794683
Provider Name (Legal Business Name): WILLIAM T JUNG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3181 SW US VETERANS HOSPITAL RD
PORTLAND OR
97001
US

IV. Provider business mailing address

15860 SW FLAGSTONE DR
BEAVERTON OR
97007
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax:
Mailing address:
  • Phone: 503-579-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7236
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: