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General NPI Number Information
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NPI Number | 1689873242
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Entity Type | Organization
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Legal Business Name | NEW SEASONS MARKET - HAPPY VALLEY
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 15861 SE HAPPY VALLEY TOWN CENTER DR.
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City | HAPPY VALLEY
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State | OR
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Zip | 97086
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Country | US
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Telephone | 503-558-9215
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Fax | 503-658-8470
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Provider Business Mailing Address
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Address Line | 15861 SE HAPPY VALLEY TOWN CENTER DR.
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City | HAPPY VALLEY
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State | OR
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Zip | 97086
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Country | US
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Telephone | 503-558-9215
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Fax | 503-658-8470
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. ERIC L FOXMAN
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Credential | R.PH.
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Telephone | 503-558-9215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | RP-0002413-CS
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | RP-0002413-CS
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP-0002413-CS
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License Number State | OR
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