Provider Demographics
NPI:1790021574
Name:MOKALLA, TRESA MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:TRESA
Middle Name:MARIE
Last Name:MOKALLA
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 1:16301 SE 82ND DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9598
Mailing Address - Country:US
Mailing Address - Phone:503-657-1575
Mailing Address - Fax:
Practice Address - Street 1:16301 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9598
Practice Address - Country:US
Practice Address - Phone:503-657-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-23
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7927183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist