# BEAVERTON PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BEAVERTON PHARMACY INC
- **Other names:** Beaverton Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639651490
- **Legal business name:** BEAVERTON PHARMACY INC
- **Authorized official:** THOMAS WADE IRBY RPH (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
- **Mailing address:** 12250 SW CANYON RD, BEAVERTON, OR 97005-2116
- **Mailing address phone:** (503) 644-2101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | RP-0000129-CS | OR | Yes |

## Other

- **Enumeration date:** 08/29/2018
- **Last updated:** 08/29/2018