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General NPI Number Information
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NPI Number | 1407183833
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Entity Type | Individual
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Provider Name | TYLER MATTHEW TREHARNE PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 5717 NE 138TH AVE
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City | PORTLAND
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State | OR
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Zip | 97230-3409
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Country | US
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Telephone | 888-572-7231
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 SW RIVER PKWY #1206
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City | PORTLAND
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State | OR
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Zip | 97239-4553
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Country | US
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Telephone | 503-338-9840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0011874
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License Number State | OR
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