Individual
DR. ETHAN ANDREW BLASHFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-7415
Mailing address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-7415
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0016144
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93-0386793
—
OR
Enumeration date
11/03/2019
Last updated
11/03/2019
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