MEDICARE: FRED POWERS PHARMD

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	RPH-0006423	OR

General Provider Information

NPI Number	:	1972081958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED POWERS PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 6149
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-0149
Country	:	US
Telephone Number	:	503-352-8657
Fax Number	:	503-352-8658

Provider Business Practice Location Address
First Line	:	2725 SW CEDAR HILLS BLVD STE 2A
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-1344
Country	:	US
Telephone Number	:	503-352-6000
Fax Number	:	503-352-6080

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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Directions to “ FRED POWERS PHARMD” Practice Location

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