Provider Demographics
NPI:1992044986
Name:GRAVES, JEFFREY JAY (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAY
Last Name:GRAVES
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 1:14700 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1417
Mailing Address - Country:US
Mailing Address - Phone:503-652-4133
Mailing Address - Fax:503-652-4120
Practice Address - Street 1:14700 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1417
Practice Address - Country:US
Practice Address - Phone:503-652-4133
Practice Address - Fax:503-652-4120
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8699183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist