Provider Demographics
NPI:1164719902
Name:MEANY, DAMION TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAMION
Middle Name:TYLER
Last Name:MEANY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MEDFORD SHOPPING CENTER
Mailing Address - Street 2:SAFEWAY 0525
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-608-3686
Mailing Address - Fax:
Practice Address - Street 1:1003 MEDFORD SHOPPING CENTER
Practice Address - Street 2:SAFEWAY 0525
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-608-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011785183500000X
ORORRPH-0011785-P1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORORRPH-0011785-POtherOREGON PHARMACIST LICENSE