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NPI Code Detail

MEDICARE: JEFFREY MANGUM

MEDICARE: JEFFREY MANGUM
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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistRPH-0013850OR
2183500000XPharmacistPH00017370WA

General Provider Information

NPI Number : 1366724551
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY MANGUM
Provider Business Mailing Address
First Line : 4849 NE 138TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-3401
Country : US
Telephone Number : 503-257-3935
Fax Number : 503-253-3747
Provider Business Practice Location Address
First Line : 4849 NE 138TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-3401
Country : US
Telephone Number : 503-257-3935
Fax Number : 503-253-3747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 12/31/2015

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Directions to “ JEFFREY MANGUM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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