Provider Demographics
NPI:1073827507
Name:JENKINS, DANIELA BEILIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:BEILIC
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 SE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4241
Mailing Address - Country:US
Mailing Address - Phone:503-775-8084
Mailing Address - Fax:
Practice Address - Street 1:5444 SE 41ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4241
Practice Address - Country:US
Practice Address - Phone:503-775-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist