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General NPI Number Information
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NPI Number | 1386013860
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Entity Type | Individual
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Provider Name | ZACHARY KORSTIAN
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Gender | Male
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 101
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City | PORTLAND
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone | 817-343-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 940 SE CESAR E CHAVEZ BLVD
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City | PORTLAND
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State | OR
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Zip | 97214-4316
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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 | 0014986
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License Number State | OR
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