Healthcare Provider Details

I. General information

NPI: 1497681290
Provider Name (Legal Business Name): COLTON CANGEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 SW 153RD AVE
BEAVERTON OR
97007-8863
US

IV. Provider business mailing address

9480 SW 153RD AVE
BEAVERTON OR
97007-8863
US

V. Phone/Fax

Practice location:
  • Phone: 661-964-7859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPI-0014564
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: