Provider Demographics
NPI:1003015165
Name:KHALILI, JESSICA J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:KHALILI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:BOSCHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-402-2946
Mailing Address - Fax:503-402-2919
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-402-2946
Practice Address - Fax:503-402-2919
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist