Healthcare Provider Details

I. General information

NPI: 1275186223
Provider Name (Legal Business Name): ANGELA MARIE MAROON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N INTERSTATE AVE
PORTLAND OR
97227-1106
US

IV. Provider business mailing address

3600 N INTERSTATE AVE
PORTLAND OR
97227-1106
US

V. Phone/Fax

Practice location:
  • Phone: 503-331-6570
  • Fax: 503-331-6575
Mailing address:
  • Phone: 503-331-6570
  • Fax: 503-331-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number9845
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: