Healthcare Provider Details

I. General information

NPI: 1871960716
Provider Name (Legal Business Name): ANDREW HIBBARD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 05/16/2024
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SW 5TH AVE
PORTLAND OR
97204-1703
US

IV. Provider business mailing address

66612 ORIOLE RD
NORTH BEND OR
97459-9490
US

V. Phone/Fax

Practice location:
  • Phone: 503-416-3395
  • Fax:
Mailing address:
  • Phone: 269-599-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH-0014909
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014909
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH-0014909
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014909
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: