Healthcare Provider Details

I. General information

NPI: 1053783423
Provider Name (Legal Business Name): AMY JORGENSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 NE 117TH AVE
VANCOUVER WA
98662-4706
US

IV. Provider business mailing address

3800 SE 22ND AVE MAIL STOP 04002/34K
PORTLAND OR
97202-2918
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-3533
  • Fax: 360-896-3527
Mailing address:
  • Phone: 503-329-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.60572119
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014890
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHRM.PH.60572119
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: