Provider Demographics
NPI:1942454129
Name:WASSOUF, JEFFREY (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WASSOUF
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 SW BARROWS RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2063
Mailing Address - Country:US
Mailing Address - Phone:503-590-4697
Mailing Address - Fax:503-590-3804
Practice Address - Street 1:14300 SW BARROWS RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2063
Practice Address - Country:US
Practice Address - Phone:503-590-4697
Practice Address - Fax:503-590-3804
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist