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NPI Code Detail

MEDICARE: FM

MEDICARE: FM
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
13336C0003XCommunity/Retail Pharmacy0015782OR

General Provider Information

NPI Number : 1114463783
Entity Type Code : Organization
Provider Name (Legal Business Name) : FM
Provider Business Mailing Address
First Line : 16575 SW PENINSULA CT
Second Line :
City : BEAVERTON
State : OR
Zip : 97006-7968
Country : US
Telephone Number : 503-839-1077
Fax Number :
Provider Business Practice Location Address
First Line : 1839 MOLALLA AVE
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-4071
Country : US
Telephone Number : 503-657-1483
Fax Number :
Authorized Official
Title or Position : PHARMACIST
Name : KIAN GHATAN
Credential :
Telephone Number : 503-839-1077
Provider Enumeration Date : 01/06/2017
Last Update Date : 01/06/2017

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Directions to “FM ” Practice Location

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