Provider Demographics
NPI:1225687981
Name:JONES, PHEBA MARIAM
Entity Type:Individual
Prefix:
First Name:PHEBA
Middle Name:MARIAM
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHEBA
Other - Middle Name:MARIAM
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13676 SW ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1525
Mailing Address - Country:US
Mailing Address - Phone:503-810-9570
Mailing Address - Fax:
Practice Address - Street 1:OHSU PHARMACY AT CHH BUILDING 2
Practice Address - Street 2:3303 SW BOND AVE RM 1090
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-346-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist