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General NPI Number Information
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NPI Number | 1154775864
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Entity Type | Organization
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Legal Business Name | SIRUM CHARITABLE PHARMACY
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 334 SE 5TH AVE STE B
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City | HILLSBORO
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State | OR
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Zip | 97123-4107
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Country | US
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Telephone | 503-648-0782
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Fax | 844-238-3420
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Provider Business Mailing Address
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Address Line | 150 ALMA ST APT 116
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City | MENLO PARK
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State | CA
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Zip | 94025-3748
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Country | US
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Telephone | 650-488-7434
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER & DIRECTOR
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Name | GEORGE WANG
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Credential |
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Telephone | 650-488-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | CP-0000014
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License Number State | OR
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