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NPI Code Detail

MEDICARE: SALLY THOMAS RPH

MEDICARE: SALLY THOMAS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist8503OR

General Provider Information

NPI Number : 1073813499
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY THOMAS RPH
Provider Business Mailing Address
First Line : 3930 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1722
Country : US
Telephone Number : 503-772-4445
Fax Number : 503-772-4448
Provider Business Practice Location Address
First Line : 3930 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1722
Country : US
Telephone Number : 503-772-4445
Fax Number : 503-772-4448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2010
Last Update Date : 11/01/2010

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Directions to “ SALLY THOMAS RPH” Practice Location

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