Provider Demographics
NPI:1871202267
Name:ESTRADA, JERROD THEODORE OPSIMA (PHARMD)
Entity type:Individual
Prefix:
First Name:JERROD THEODORE
Middle Name:OPSIMA
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 S RIVER PKWY APT 510
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4748
Mailing Address - Country:US
Mailing Address - Phone:916-622-7393
Mailing Address - Fax:
Practice Address - Street 1:6850 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-6247
Practice Address - Country:US
Practice Address - Phone:503-240-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist