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General NPI Number Information
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NPI Number | 1235882747
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Entity Type | Individual
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Provider Name | RENITA PATEL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3098
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Country | US
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Telephone | 503-494-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD, MAIL CODE: CR 9-4
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60223049
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21786
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0013382
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License Number State | OR
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