Healthcare Provider Details

I. General information

NPI: 1346681210
Provider Name (Legal Business Name): JASON SCOTT RENOUD RPH, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST ST
SCOTTS MILLS OR
97375-7002
US

IV. Provider business mailing address

PO BOX 335
SCOTTS MILLS OR
97375-0335
US

V. Phone/Fax

Practice location:
  • Phone: 503-551-7170
  • Fax:
Mailing address:
  • Phone: 503-551-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH-0009029
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: