Provider Demographics
NPI:1245820497
Name:GREGORY, HEATHER PAGE (RPH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:PAGE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29757 SW HEATER RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-5005
Mailing Address - Country:US
Mailing Address - Phone:916-599-9957
Mailing Address - Fax:
Practice Address - Street 1:13221 SW 68TH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8328
Practice Address - Country:US
Practice Address - Phone:916-926-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511061835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric