Provider Demographics
NPI:1326427006
Name:JUNGMANN, PATRICIA MAE (BSPHARM)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MAE
Last Name:JUNGMANN
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 NE ROSEMONT ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1370
Mailing Address - Country:US
Mailing Address - Phone:503-931-9551
Mailing Address - Fax:
Practice Address - Street 1:1575 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2907
Practice Address - Country:US
Practice Address - Phone:541-447-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist