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General NPI Number Information
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NPI Number | 1720804016
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Entity Type | Individual
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Provider Name | KATHERE LYON
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 4400 NE HALSEY ST STE 490
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City | PORTLAND
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State | OR
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Zip | 97213-1545
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Country | US
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Telephone | 503-893-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 SW 4TH AVE APT 1112
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City | PORTLAND
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State | OR
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Zip | 97201-5553
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Country | US
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Telephone | 949-310-4778
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | PI-0014419
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License Number State | OR
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