Provider Demographics
NPI:1699222679
Name:DAVIS, LAURA (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N. INTERSTATE AVE
Mailing Address - Street 2:KAISER PERMANENTE EIN PHARMACY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1097
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3550 N. INTERSTATE AVE
Practice Address - Street 2:KAISER PERMANENTE EIN PHARMACY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1097
Practice Address - Country:US
Practice Address - Phone:503-249-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8324183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist