MEDICARE: EDWIN GRANT SHERWOOD PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60879431	WA
2	183500000X	Pharmacist	RPH0016808	OR

General Provider Information

NPI Number	:	1235607722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN GRANT SHERWOOD PHARMD

Provider Business Mailing Address
First Line	:	5104 SE RURAL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-8366
Country	:	US
Telephone Number	:	501-827-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 NW LOST SPRINGS TER STE 36
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-6571
Country	:	US
Telephone Number	:	503-596-3552
Fax Number	:	503-596-3558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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Directions to “ EDWIN GRANT SHERWOOD PHARMD” Practice Location

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