Healthcare Provider Details

I. General information

NPI: 1558621474
Provider Name (Legal Business Name): ABBAS ABBASPOUR PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22075 NW IMBRIE DR
HILLSBORO OR
97209-1029
US

IV. Provider business mailing address

22075 NW IMBRIE DR
HILLSBORO OR
97124-7578
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-1133
  • Fax: 503-747-1127
Mailing address:
  • Phone: 503-747-4113
  • Fax: 503-747-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6512
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0006251
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: