Provider Demographics
NPI:1104113075
Name:NELSON, JANICE R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13595 SW ROAN CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7518
Mailing Address - Country:US
Mailing Address - Phone:503-639-3446
Mailing Address - Fax:503-639-3446
Practice Address - Street 1:9009 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4432
Practice Address - Country:US
Practice Address - Phone:503-639-3446
Practice Address - Fax:503-639-3446
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist