Provider Demographics
NPI:1891263448
Name:HELTON, JACOB (RPH)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:HELTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 NW ROMANE PL APT 7202
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6082
Mailing Address - Country:US
Mailing Address - Phone:618-521-4139
Mailing Address - Fax:
Practice Address - Street 1:2836 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1896
Practice Address - Country:US
Practice Address - Phone:503-359-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist