Provider Demographics
NPI:1467075598
Name:CHING, MARILANI SU (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARILANI
Middle Name:SU
Last Name:CHING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 SE HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7409
Mailing Address - Country:US
Mailing Address - Phone:503-267-3344
Mailing Address - Fax:
Practice Address - Street 1:1015 NW 22ND AVENUE
Practice Address - Street 2:PHARMACY SERVICES
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-412-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00067251835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy