=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821438557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY KOGA PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 04/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11565 SW PACIFIC HWY
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-293-7085
-----------------------------------------------------
Fax | 503-293-7078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11565 SW PACIFIC HWY
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-293-7085
-----------------------------------------------------
Fax | 503-293-7078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 11962
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 3053
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 11962
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------