Healthcare Provider Details

I. General information

NPI: 1801461264
Provider Name (Legal Business Name): OMAR VARGAS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

IV. Provider business mailing address

PO BOX 6149
ALOHA OR
97007-0149
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-6000
  • Fax: 503-352-6080
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPI-0013259
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: