Healthcare Provider Details

I. General information

NPI: 1699244749
Provider Name (Legal Business Name): SOHROB YAVARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14742 SW SCHOLLS FERRY RD
BEAVERTON OR
97007-9108
US

IV. Provider business mailing address

PO BOX 23544
TIGARD OR
97281-3544
US

V. Phone/Fax

Practice location:
  • Phone: 971-205-0118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0016993
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: