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General NPI Number Information
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NPI Number | 1982917738
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Entity Type | Individual
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Provider Name | JESSE CALDWELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 100 SW MARKET ST MS WW3-33
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City | PORTLAND
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State | OR
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Zip | 97201-5723
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Country | US
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Telephone | 503-225-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 7931 SW 40TH AVE UNIT I
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City | PORTLAND
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State | OR
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Zip | 97219-3598
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Country | US
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Telephone | 415-235-7101
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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 | 051.294357
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License Number State | IL
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