Basic Information
Provider Information
NPI: 1548280274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: NATASHA
MiddleName: DANIKA
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3710 SW US VETERANS HOSPITAL RD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972392964
CountryCode: US
TelephoneNumber: 5032208262
FaxNumber: 5034022919
Practice Location
Address1: 3710 SW US VETERANS HOSPITAL RD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972392964
CountryCode: US
TelephoneNumber: 5032208262
FaxNumber: 5034022919
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 06/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X52584CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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