Provider Demographics
NPI:1831562065
Name:KING, JOSEPH EDWARD IV (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:KING
Suffix:IV
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SE MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2634
Mailing Address - Country:US
Mailing Address - Phone:503-623-2400
Mailing Address - Fax:503-623-5799
Practice Address - Street 1:625 SE MILLER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2634
Practice Address - Country:US
Practice Address - Phone:503-623-2400
Practice Address - Fax:503-623-5799
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013214183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist