Provider Demographics
NPI:1346499225
Name:JAFARI, ANITA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:JAFARI
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 1:5640 SW STOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3884
Mailing Address - Country:US
Mailing Address - Phone:503-789-0752
Mailing Address - Fax:
Practice Address - Street 1:16199 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-635-6630
Practice Address - Fax:503-635-6633
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist