Organization
BEAVERTON PHARMACY INC
Active
Other names
Beaverton Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS IRBY (PRESIDENT)
(503) 644-2101
Entity
Organization
Contact information
Practice address
12250 SW CANYON RD, BEAVERTON, OR 97005-2116
(503) 644-2101
(503) 626-8698
Mailing address
12250 SW CANYON RD, BEAVERTON, OR 97005-2116
(503) 644-2101
(503) 626-8698
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0000129-CS
OR
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007807
—
OR
01
—
2148247
PK
—
Enumeration date
05/28/2006
Last updated
12/12/2019
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