Healthcare Provider Details

I. General information

NPI: 1154611440
Provider Name (Legal Business Name): CHAD TERUO KOBAYASHI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 SW WALKER RD
BEAVERTON OR
97005-1306
US

IV. Provider business mailing address

12575 SW WALKER RD
BEAVERTON OR
97005-1306
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-2423
  • Fax: 503-646-5094
Mailing address:
  • Phone: 503-646-2423
  • Fax: 503-646-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011076
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: