Provider Demographics
NPI:1942343025
Name:JOSS, JACQUELINE D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:D
Last Name:JOSS
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 1:6088 SW GRAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3973
Mailing Address - Country:US
Mailing Address - Phone:541-768-5286
Mailing Address - Fax:541-768-6583
Practice Address - Street 1:3615 NW SAMARITAN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3783
Practice Address - Country:US
Practice Address - Phone:541-768-6286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18250183500000X
OR00100931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist