Provider Demographics
NPI:1912208331
Name:OWENS, ELIZAH A (RPH)
Entity type:Individual
Prefix:
First Name:ELIZAH
Middle Name:A
Last Name:OWENS
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 1:3930 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1722
Mailing Address - Country:US
Mailing Address - Phone:503-772-4445
Mailing Address - Fax:503-772-4448
Practice Address - Street 1:3930 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1722
Practice Address - Country:US
Practice Address - Phone:503-772-4445
Practice Address - Fax:503-772-4448
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9405183500000X
OR00090451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist