Basic Information
| Provider Information | |||||||||
| NPI: | 1528289998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUKE | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | CHIEKO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 NE HALSEY ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972131545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038936904 | ||||||||
| FaxNumber: | 5038936913 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 NE HALSEY ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972131545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038936904 | ||||||||
| FaxNumber: | 5038936913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 08/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | RPH0009668 | OR | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.