Healthcare Provider Details

I. General information

NPI: 1346300159
Provider Name (Legal Business Name): BOARDMAN HARDWARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N.W. FIRST
BOARDMAN OR
97818
US

IV. Provider business mailing address

PO BOX 170
BOARDMAN OR
97818-0170
US

V. Phone/Fax

Practice location:
  • Phone: 541-481-9474
  • Fax: 541-481-2151
Mailing address:
  • Phone: 541-481-9474
  • Fax: 541-481-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4971
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND D. MICHAEL
Title or Position: CORPORATION PRESIDENT
Credential: R. PH.
Phone: 541-481-9474