BEAVERTON PHARMACY INC (NPI# 1639651490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639651490 |
| Entity Type | Organization |
| Organization Name | BEAVERTON PHARMACY INC |
| Other Organization Name | BEAVERTON PHARMACY |
| Practice Address |
12250 Sw Canyon Rd Beaverton OR 97005-2116 |
| Practice Telephone | 5036442101 |
| Mailing Telephone | 5036442101 |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-08-29 |
| Authorized Official Name | THOMAS WADE IRBY (PRESIDENT) |
| Authorized Official Telephone | 5036442101 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | Y |
| Parent Organization Name | BEAVERTON PHARMACY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
RP-0000129-CS | OR | Suppliers |
| Other Name | Type Code |
|---|---|
| Beaverton Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548217136 | Beaverton Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 12250 Sw Canyon Rd, Beaverton, OR 97005-2116 | 2006-05-28 |
| Street Address |
12250 SW CANYON RD |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-2116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548217136 | Beaverton Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 12250 Sw Canyon Rd, Beaverton, OR 97005-2116 | 2006-05-28 |
| 1538610746 | Lawrence Reid | Pharmacist | 12250 Sw Canyon Rd, Beaverton, OR 97005-2116 | 2016-10-23 |
| 1477726313 | Mark E Sargeant | Pharmacist | 12250 Sw Canyon Rd, Beaverton, OR 97005-2116 | 2008-04-11 |
| 1598989311 | Thomas Wade Irby | Pharmacist | 12250 Sw Canyon Rd, Beaverton, OR 97005-2116 | 2007-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1023440864 | Olson Pharmacy Services | Pharmacy | 617 Monroe St, Oregon City, OR 97045-2336 | 2013-08-03 |
| 1861773798 | Grants Pass Pharmacy, Inc. | Pharmacy | 414 Sw 6th St., Grants Pass, OR 97526-2810 | 2011-09-06 |
| 1003051558 | Howard's Pharmacy Inc. | Pharmacy | 101 N F St, Lakeview, OR 97630-1529 | 2008-12-12 |
| 1558448225 | Pill Box Drugs Inc | Pharmacy | 635 N Arrowleaf Trl, Sisters, OR 97759 | 2006-11-01 |
| 1881776722 | Quisenberry Pharmacies Inc. | Pharmacy | 150 Liberty St Se, Salem, OR 97301-3506 | 2006-10-19 |
| 1093808198 | Pill Box Drugs Inc | Pharmacy | 906 Nw Kings Blvd, Corvallis, OR 97330 | 2006-10-02 |
| 1871690719 | Pill Box Drugs Inc | Pharmacy | 910 Nw Kings Blvd, Corvallis, OR 97330-2505 | 2006-09-20 |
| 1952405664 | Dept. of Human Srvcs/office of Fin. Srvcs Dba Irs/eopc/eotc/osh/osh-p | Pharmacy | 2600 Westgate, Pendleton, OR 97801-9604 | 2006-09-12 |
| 1780795765 | Evergreen Pharmaceutical, LLC | Pharmacy | 259 E Barnett Rd Ste L, Medford, OR 97501-7953 | 2006-08-31 |
| 1235240391 | Evergreen Pharmaceutical, LLC | Pharmacy | 11933 Ne Glenn Widing Dr, Portland, OR 97220-9099 | 2006-08-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.