Provider Demographics
NPI:1215201223
Name:FLESCH, JAY P (RPH)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:FLESCH
Suffix:
Gender:M
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:PO BOX 3999
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-3999
Mailing Address - Country:US
Mailing Address - Phone:541-771-7457
Mailing Address - Fax:541-783-3554
Practice Address - Street 1:330 S CHILOQUIN BLVD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624-6747
Practice Address - Country:US
Practice Address - Phone:541-783-3551
Practice Address - Fax:541-783-3554
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist