MEDICARE: JILL E ROSA PHARMD

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	183500000X	Pharmacist	RPH-0011896	OR

General Provider Information

NPI Number	:	1588997548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL E ROSA PHARMD

Provider Business Mailing Address
First Line	:	4911 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	765-914-3893
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 NE GLISAN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-2933
Country	:	US
Telephone Number	:	503-215-1111
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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Directions to “ JILL E ROSA PHARMD” Practice Location

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