Provider Demographics
NPI:1346681210
Name:RENOUD, JASON SCOTT (RPH, CGP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:RENOUD
Suffix:
Gender:M
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:SCOTTS MILLS
Mailing Address - State:OR
Mailing Address - Zip Code:97375-0335
Mailing Address - Country:US
Mailing Address - Phone:503-551-7170
Mailing Address - Fax:
Practice Address - Street 1:550 1ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTS MILLS
Practice Address - State:OR
Practice Address - Zip Code:97375-7002
Practice Address - Country:US
Practice Address - Phone:503-551-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00090291835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric