Provider Demographics
NPI:1316948276
Name:MCELRAVEY, JENNIFER BECKHAM (RPH)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BECKHAM
Last Name:MCELRAVEY
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 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-941-3033
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-2302
Practice Address - Country:US
Practice Address - Phone:503-941-3160
Practice Address - Fax:503-336-0363
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040694183500000X
ORRPH-00094271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1316948276Medicaid