NPI 1003114935

Aida Wijaya

Practitioner Pharmacist Portland, OR

Practice location

Address: 8330 N Ivanhoe St, Portland, OR 97203-4824
Phone: (503) 205-1600

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 0010283 (OR)

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Registry record

NPI: 1003114935
Entity type: Individual
Sex (as registered): Female
NPI issued: 1 Mar 2011
Record last updated: 1 Mar 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.