Organization
BEAVERTON PHARMACY INC
Active
Parent organization
BEAVERTON PHARMACY INC
Other names
Beaverton Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEAVERTON PHARMACY INC
Authorized official
THOMAS WADE IRBY RPH (PRESIDENT)
(503) 644-2101
Entity
Organization
Contact information
Practice address
12250 SW CANYON RD, BEAVERTON, OR 97005-2116
(503) 644-2101
Mailing address
12250 SW CANYON RD, BEAVERTON, OR 97005-2116
(503) 644-2101
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
RP-0000129-CS
OR
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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