Provider Demographics
NPI:1114593589
Name:KOLAS, JADEN SCHAEN (CPHT)
Entity Type:Individual
Prefix:
First Name:JADEN
Middle Name:SCHAEN
Last Name:KOLAS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1484
Mailing Address - Country:US
Mailing Address - Phone:541-753-2226
Mailing Address - Fax:
Practice Address - Street 1:2080 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1484
Practice Address - Country:US
Practice Address - Phone:541-753-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0013323183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician