Provider Demographics
NPI:1528304599
Name:COFFEY, JOEL R JR (RPH)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:COFFEY
Suffix:JR
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 1:3030 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1851
Mailing Address - Country:US
Mailing Address - Phone:503-280-1333
Mailing Address - Fax:503-280-1327
Practice Address - Street 1:3030 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1851
Practice Address - Country:US
Practice Address - Phone:503-280-1333
Practice Address - Fax:503-280-1327
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH00068881835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist