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General NPI Number Information
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NPI Number | 1992448880
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Entity Type | Individual
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Provider Name | JESSICA LASSITER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-418-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 9720 SW 74TH AVE
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City | TIGARD
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State | OR
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Zip | 97223-1116
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Country | US
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Telephone | 608-215-1135
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0011132
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License Number State | OR
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