Healthcare Provider Details

I. General information

NPI: 1528548542
Provider Name (Legal Business Name): HENRY SAEDI-KWON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2018
Last Update Date: 08/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SE 8TH AVE
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

3939 SW BOND AVE APT 408
PORTLAND OR
97239-4688
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-7307
  • Fax:
Mailing address:
  • Phone: 425-635-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60770311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: