Individual
ANTHONY F. DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
17108 SE POWELL BLVD, PORTLAND, OR 97236-1753
(503) 667-5377
(503) 666-9257
Mailing address
17108 SE POWELL BLVD, PORTLAND, OR 97236-1753
(503) 667-5377
(503) 666-9257
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0005733
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0005733
STATE PHARMACIST LICENSE
OR
Enumeration date
02/17/2012
Last updated
02/17/2012
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