Healthcare Provider Details

I. General information

NPI: 1679976997
Provider Name (Legal Business Name): GAVIN BARRY NEWBOLD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 PORTLAND RD
NEWBERG OR
97132-1847
US

IV. Provider business mailing address

4200 SW 107TH AVE APT 2504
BEAVERTON OR
97005-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0014398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: