Provider Demographics
NPI:1013624220
Name:JAQUA, VI THUY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VI
Middle Name:THUY
Last Name:JAQUA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:VI
Other - Middle Name:THUY
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:34320 MCKENZIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9205
Mailing Address - Country:US
Mailing Address - Phone:503-481-4563
Mailing Address - Fax:
Practice Address - Street 1:47809 OR-58
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463
Practice Address - Country:US
Practice Address - Phone:541-782-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00113881835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist