Healthcare Provider Details

I. General information

NPI: 1144772419
Provider Name (Legal Business Name): SHAWNA L LAXSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 NE SANDY BLVD
PORTLAND OR
97213-5741
US

IV. Provider business mailing address

7206 NE SANDY BLVD
PORTLAND OR
97213-5741
US

V. Phone/Fax

Practice location:
  • Phone: 503-284-1159
  • Fax: 503-281-1211
Mailing address:
  • Phone: 503-284-1159
  • Fax: 503-281-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0008687
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00022210
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH456974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: