Provider Demographics
NPI:1346598984
Name:SCHETTINI, ERIC JON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JON
Last Name:SCHETTINI
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 1:13511 SE CLAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1746
Mailing Address - Country:US
Mailing Address - Phone:360-571-2575
Mailing Address - Fax:877-302-0306
Practice Address - Street 1:5050 NE HOYT ST STE 222
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2980
Practice Address - Country:US
Practice Address - Phone:503-215-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013265183500000X, 1835P0018X
WAPH60306544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist