Provider Demographics
NPI:1134801715
Name:ROBISON, JASON WING (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WING
Last Name:ROBISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:K
Other - Last Name:WING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7631 N WOOLSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5836
Mailing Address - Country:US
Mailing Address - Phone:317-674-6233
Mailing Address - Fax:
Practice Address - Street 1:8215 SW TUALATIN SHERWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8620
Practice Address - Country:US
Practice Address - Phone:503-607-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist