Provider Demographics
NPI:1821438557
Name:KOGA, WENDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KOGA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8845
Mailing Address - Country:US
Mailing Address - Phone:503-293-7085
Mailing Address - Fax:503-293-7078
Practice Address - Street 1:11565 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8845
Practice Address - Country:US
Practice Address - Phone:503-293-7085
Practice Address - Fax:503-293-7078
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11962183500000X, 1835P0018X
HI3053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist