Provider Demographics
NPI:1104192418
Name:SELE, EUGENE ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ROBERT
Last Name:SELE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 SW RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3047
Mailing Address - Country:US
Mailing Address - Phone:503-292-5109
Mailing Address - Fax:503-291-5240
Practice Address - Street 1:6745 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1484
Practice Address - Country:US
Practice Address - Phone:503-296-7226
Practice Address - Fax:503-296-7228
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4443183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist