Provider Demographics
NPI:1760786057
Name:IAZZETTI, PATRICIA WITTKE (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WITTKE
Last Name:IAZZETTI
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 1:6290 ALYSSA TER
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3183
Mailing Address - Country:US
Mailing Address - Phone:971-678-0639
Mailing Address - Fax:
Practice Address - Street 1:6290 ALYSSA TER
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3183
Practice Address - Country:US
Practice Address - Phone:971-678-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist