Provider Demographics
NPI:1366948465
Name:KEMPTON-HEIN, MALLORY ALYSE (PHARMD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ALYSE
Last Name:KEMPTON-HEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11956 SW GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8248
Mailing Address - Country:US
Mailing Address - Phone:503-941-3807
Mailing Address - Fax:503-941-3809
Practice Address - Street 1:11956 SW GARDEN PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8248
Practice Address - Country:US
Practice Address - Phone:503-941-3807
Practice Address - Fax:503-941-3809
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60901499183500000X
AK116592183500000X
CA75604183500000X
OR0016025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0016025OtherPHARMACIST LICENSE