Healthcare Provider Details

I. General information

NPI: 1275563322
Provider Name (Legal Business Name): CORINNE ASHLEY MUIRHEAD PHARMD, BCPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

17043 SW RIVENDELL DR
TIGARD OR
97224-7624
US

V. Phone/Fax

Practice location:
  • Phone: 503-351-9177
  • Fax:
Mailing address:
  • Phone: 206-851-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberIR00053167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: