Provider Demographics
NPI:1235313214
Name:CHAMBERLAIN, JEFF (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 NE 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2421
Mailing Address - Country:US
Mailing Address - Phone:503-701-2086
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2971
Practice Address - Country:US
Practice Address - Phone:503-413-6555
Practice Address - Fax:503-413-6563
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1736183500000X
ORRPH-0011117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist