Healthcare Provider Details

I. General information

NPI: 1558624593
Provider Name (Legal Business Name): JESSICA COLLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51501 COLUMBIA RIVER HWY
SCAPPOOSE OR
97056-4539
US

IV. Provider business mailing address

51501 COLUMBIA RIVER HWY
SCAPPOOSE OR
97056-4539
US

V. Phone/Fax

Practice location:
  • Phone: 503-543-4533
  • Fax: 503-543-4527
Mailing address:
  • Phone: 503-543-4533
  • Fax: 503-543-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00070740
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0012875
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0012875
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH 00070740
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: