Provider Demographics
NPI:1467855056
Name:FENRICH, JONATHAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:FENRICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9363 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3360
Mailing Address - Country:US
Mailing Address - Phone:503-292-1146
Mailing Address - Fax:503-292-1144
Practice Address - Street 1:9363 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3360
Practice Address - Country:US
Practice Address - Phone:503-292-1146
Practice Address - Fax:503-292-1144
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR84151835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist