Provider Demographics
NPI:1689006041
Name:KRUEGER, JEFF
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:KRUEGER
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 1:1839 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4011
Mailing Address - Country:US
Mailing Address - Phone:503-656-4318
Mailing Address - Fax:503-657-1480
Practice Address - Street 1:1839 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4011
Practice Address - Country:US
Practice Address - Phone:503-656-4318
Practice Address - Fax:503-657-1480
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORRPH00108941835P1200X
OR00108941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy