Healthcare Provider Details

I. General information

NPI: 1366314403
Provider Name (Legal Business Name): FIREHIWOT G. REGASSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17495 SW FARMINGTON RD
ALOHA OR
97007-3212
US

IV. Provider business mailing address

17495 SW FARMINGTON RD
ALOHA OR
97007-3212
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-7700
  • Fax:
Mailing address:
  • Phone: 503-848-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0019219
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: