Healthcare Provider Details

I. General information

NPI: 1740573351
Provider Name (Legal Business Name): USSAH MANYRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N SPRINGBROOK RD
NEWBERG OR
97132-2007
US

IV. Provider business mailing address

9441 SW 164TH AVE
BEAVERTON OR
97007-9415
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7402
  • Fax:
Mailing address:
  • Phone: 503-307-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0008591
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: