Provider Demographics
NPI:1164931416
Name:ZANGLA, JORDAN L (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:L
Last Name:ZANGLA
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 SE HAWTHORNE BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3300
Mailing Address - Country:US
Mailing Address - Phone:443-617-5272
Mailing Address - Fax:
Practice Address - Street 1:18110 SE 34TH ST STE 270
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:800-330-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016149183500000X
MD25179183500000X
WAPH60823134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist