MEDICARE: SOKHEMRY PENH YI R.PH.

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	9567	OR

General Provider Information

NPI Number	:	1538313978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOKHEMRY PENH YI R.PH.

Provider Business Mailing Address
First Line	:	36288 SW BALD PEAK RD
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-9031
Country	:	US
Telephone Number	:	503-628-4987
Fax Number	:

Provider Business Practice Location Address
First Line	:	14600 SW MURRAY SCHOLLS DR
Second Line	:	SUITE 201
City	:	BEAVERTON
State	:	OR
Zip	:	97007-9712
Country	:	US
Telephone Number	:	503-579-1878
Fax Number	:	503-579-0988

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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