Provider Demographics
NPI:1306391800
Name:ROQUE, JOHN PAUL PEKSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN PAUL
Middle Name:PEKSON
Last Name:ROQUE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:PEKSON
Other - Last Name:ROQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2300 SW 214TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7700 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2101
Practice Address - Country:US
Practice Address - Phone:503-203-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015448183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist