Provider Demographics
NPI:1255704649
Name:SCHUTZBACH, JEFFREY SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SCHUTZBACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SW 194TH CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1942
Mailing Address - Country:US
Mailing Address - Phone:815-351-4350
Mailing Address - Fax:
Practice Address - Street 1:15685 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2651
Practice Address - Country:US
Practice Address - Phone:503-639-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60611558183500000X
ORRPH-0015084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist