Provider Demographics
NPI:1629597414
Name:AL JAMAL, NOUR (RPH)
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:
Last Name:AL JAMAL
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 1:7575 SW ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9076
Mailing Address - Country:US
Mailing Address - Phone:503-867-9270
Mailing Address - Fax:
Practice Address - Street 1:3002 STACY ALLISON WAY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2904
Practice Address - Country:US
Practice Address - Phone:503-981-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist