Healthcare Provider Details

I. General information

NPI: 1447460100
Provider Name (Legal Business Name): FIROZ YUSUFALI DAWOODBHAI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FIROZ DAWOODBHAI RPH

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SW 72ND AVE PAYLESS PHARMACY
PORTLAND OR
97224-7745
US

IV. Provider business mailing address

7865 SW 186TH AVE
BEAVERTON OR
97007-5683
US

V. Phone/Fax

Practice location:
  • Phone: 503-372-1714
  • Fax: 503-372-1972
Mailing address:
  • Phone: 503-848-7864
  • Fax: 503-372-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1157143
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12527
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: