# BEAVERTON PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beaverton Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548217136
- **Authorized official:** THOMAS IRBY (PRESIDENT)
- **Authorized official phone:** (503) 644-2101

## Contact information

- **Practice address:** 12250 SW CANYON RD, BEAVERTON, OR 97005-2116
- **Practice address phone:** (503) 644-2101
- **Practice address fax:** (503) 626-8698
- **Mailing address:** 12250 SW CANYON RD, BEAVERTON, OR 97005-2116
- **Mailing address phone:** (503) 644-2101
- **Mailing address fax:** (503) 626-8698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0000129-CS | OR | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/28/2006
- **Last updated:** 12/12/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 007807 | — | OR |
| 01 | — | 2148247 | PK | — |