MEDICARE: DR. RAMIN JABERABO ANSARI 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	10198	OR
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	10198	OR

General Provider Information

NPI Number	:	1710250790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMIN JABERABO ANSARI PHARMD

Provider Business Mailing Address
First Line	:	650 Q ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-2353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 Q ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-2353
Country	:	US
Telephone Number	:	541-741-5183
Fax Number	:

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

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	04/28/2017

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