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General NPI Number Information
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NPI Number | 1316235633
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Entity Type | Individual
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Provider Name | ELIZABETH M WAIGUCHU JACKSON PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 13010 SW 68TH PKWY STE 140
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City | TIGARD
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State | OR
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Zip | 97223-9621
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Country | US
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Telephone | 503-210-2548
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 823003
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City | VANCOUVER
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State | WA
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Zip | 98682-0063
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Country | US
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Telephone | 503-801-7521
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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 | RPH-0011663
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License Number State | OR
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