MEDICARE: DR. ALI OLYAEI

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	1835P1200X	Pharmacotherapy Pharmacist	RPH-0007764	OR

General Provider Information

NPI Number	:	1730795212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI OLYAEI

Provider Business Mailing Address
First Line	:	3181 SW SAM JACKSON PARK RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3098
Country	:	US
Telephone Number	:	503-494-8132
Fax Number	:

Provider Business Practice Location Address
First Line	:	13852 AMBERWOOD CIR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-6716
Country	:	US
Telephone Number	:	503-830-8100
Fax Number	:

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

Provider Enumeration Date	:	09/19/2020
Last Update Date	:	09/19/2020

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