| NPI | 1114274289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN JAMES FENRICH Owner 503-292-1146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: OR RP-0002724) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-08-08 |