MEDICARE: MR. SINAC KHIEV

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
1	183500000X	Pharmacist	8193	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8193	OTHER	OR	STATE PHARMACIST LICENSE

General Provider Information

NPI Number	:	1528319878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SINAC KHIEV

Provider Business Mailing Address
First Line	:	2075 SE TUALATIN VALLEY HWY
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-5058
Country	:	US
Telephone Number	:	503-640-3777
Fax Number	:	866-273-1395

Provider Business Practice Location Address
First Line	:	2075 SE TUALATIN VALLEY HWY
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-5058
Country	:	US
Telephone Number	:	503-640-3777
Fax Number	:	866-273-1395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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Directions to “ MR. SINAC KHIEV ” Practice Location

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