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General NPI Number Information
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NPI Number | 1265695456
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Entity Type | Organization
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Legal Business Name | FAIRLEY'S RX INC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 7206 NE SANDY BLVD SUITE B
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City | PORTLAND
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State | OR
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Zip | 97213
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Country | US
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Telephone | 503-281-7500
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Fax | 503-281-1211
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Provider Business Mailing Address
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Address Line | 7206 NE SANDY BLVD STE:B
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City | PORTLAND
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State | OR
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Zip | 97213-5741
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Country | US
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Telephone | 503-281-7500
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Fax | 503-281-7505
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DANIEL LEE
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Credential | PHARMD.
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Telephone | 425-802-1891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | IP0002182CS
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License Number State | OR
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