=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093338980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANA WORTHY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2020
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1123 N HAYDEN MEADOWS DR
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97217-7547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-205-6661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16250 PACIFIC HWY UNIT 45
-----------------------------------------------------
City | LAKE OSWEGO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97034-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-954-7288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH0017698
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------