Provider Demographics
NPI:1669632337
Name:ERNST, TJ
Entity Type:Individual
Prefix:
First Name:TJ
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15901 SW JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5098
Mailing Address - Country:US
Mailing Address - Phone:503-626-5754
Mailing Address - Fax:503-626-1187
Practice Address - Street 1:15901 SW JENKINS RD
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-5098
Practice Address - Country:US
Practice Address - Phone:503-626-5754
Practice Address - Fax:503-626-1187
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20261835P0018X
OR93991835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist