MEDICARE: ALISON JOY PRIEST CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	CPT-0005490	OR

General Provider Information

NPI Number	:	1033714654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON JOY PRIEST CPHT

Provider Business Mailing Address
First Line	:	PO BOX 2061
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-1813
Country	:	US
Telephone Number	:	503-334-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	23500 NE SANDY BLVD
Second Line	:
City	:	WOOD VILLAGE
State	:	OR
Zip	:	97060-9653
Country	:	US
Telephone Number	:	503-334-5139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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