Healthcare Provider Details

I. General information

NPI: 1487364014
Provider Name (Legal Business Name): GERISSA ABDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 SW ALLEN BLVD
BEAVERTON OR
97007-3697
US

IV. Provider business mailing address

14625 SW ALLEN BLVD
BEAVERTON OR
97007-3697
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-2724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0019272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: