Healthcare Provider Details

I. General information

NPI: 1164931416
Provider Name (Legal Business Name): JORDAN L ZANGLA RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18110 SE 34TH ST STE 270
VANCOUVER WA
98683
US

IV. Provider business mailing address

4717 SE HAWTHORNE BLVD APT 205
PORTLAND OR
97215-3300
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-3665
  • Fax:
Mailing address:
  • Phone: 443-617-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0016149
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25179
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60823134
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: