Healthcare Provider Details

I. General information

NPI: 1649157348
Provider Name (Legal Business Name): ANTHONY MANZON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SE 82ND AVE
HAPPY VALLEY OR
97086-3765
US

IV. Provider business mailing address

13403 SE PORTLAND VIEW PL
HAPPY VALLEY OR
97086-6399
US

V. Phone/Fax

Practice location:
  • Phone: 503-575-0244
  • Fax:
Mailing address:
  • Phone: 503-575-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0020621
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0020621
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: