Healthcare Provider Details

I. General information

NPI: 1407995277
Provider Name (Legal Business Name): GARY OWINGS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD B3
TUALATIN OR
97062
US

IV. Provider business mailing address

6464 SW BORLAND RD B3 CENTER PHARMACY
TUALATIN OR
97062
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-4446
  • Fax:
Mailing address:
  • Phone: 503-692-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5555
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: