Provider Demographics
NPI:1629341037
Name:SACHTJEN, JERRY GARY (RPH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:GARY
Last Name:SACHTJEN
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 1:1230 LANCASTER DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5800
Mailing Address - Country:US
Mailing Address - Phone:503-371-6830
Mailing Address - Fax:503-371-8159
Practice Address - Street 1:1230 LANCASTER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5800
Practice Address - Country:US
Practice Address - Phone:503-371-6830
Practice Address - Fax:503-371-8159
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist