Provider Demographics
NPI:1487018743
Name:AYANO, CHANEL
Entity Type:Individual
Prefix:DR
First Name:CHANEL
Middle Name:
Last Name:AYANO
Suffix:
Gender:F
Credentials:
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 230969
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-0969
Mailing Address - Country:US
Mailing Address - Phone:800-330-3665
Mailing Address - Fax:800-982-2730
Practice Address - Street 1:2920 CHAD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7343
Practice Address - Country:US
Practice Address - Phone:503-626-9436
Practice Address - Fax:503-372-1792
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014323183500000X
HIPH-3414183500000X
NE14017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist