Provider Demographics
NPI:1528619608
Name:WILL, ROGER SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:SCOTT
Last Name:WILL
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 1:960 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9646
Mailing Address - Country:US
Mailing Address - Phone:503-551-4171
Mailing Address - Fax:503-873-2900
Practice Address - Street 1:916 W EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3035
Practice Address - Country:US
Practice Address - Phone:503-873-8391
Practice Address - Fax:503-873-2900
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00079161835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist