Healthcare Provider Details

I. General information

NPI: 1528680006
Provider Name (Legal Business Name): HEATHER NORVELLE-MINAMOTO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER NORVELLE-MINAMOTO PHARMAD

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
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

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

V. Phone/Fax

Practice location:
  • Phone: 503-494-0087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRPH-0010876
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: