Provider Demographics
NPI:1275848798
Name:BLOCHER, JERROLD P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:P
Last Name:BLOCHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW MARSHALL ST STE 508
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3168
Mailing Address - Country:US
Mailing Address - Phone:765-426-3362
Mailing Address - Fax:
Practice Address - Street 1:13939 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4838
Practice Address - Country:US
Practice Address - Phone:503-670-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist