Provider Demographics
NPI:1275825853
Name:CHINN, BENJAMIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:CHINN
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 1:1255 NE 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5008
Mailing Address - Country:US
Mailing Address - Phone:503-681-2828
Mailing Address - Fax:503-681-2825
Practice Address - Street 1:15901 SW JENKINS RD
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-5045
Practice Address - Country:US
Practice Address - Phone:503-626-5754
Practice Address - Fax:503-626-1187
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7453183500000X
ORRPH00074531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist