Healthcare Provider Details

I. General information

NPI: 1316457104
Provider Name (Legal Business Name): AUSTIN PLISKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 A AVE STE 200
LAKE OSWEGO OR
97034-3078
US

IV. Provider business mailing address

15272 SW MILLIKAN WAY APT 433
BEAVERTON OR
97003-6610
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-2496
  • Fax: 503-635-2497
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0016296
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0016296
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: