Provider Demographics
NPI:1497931604
Name:FLANDERS PHARMACY
Entity Type:Organization
Organization Name:FLANDERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-228-4119
Mailing Address - Street 1:2330 NW FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-228-4119
Mailing Address - Fax:503-228-4119
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE G2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-228-4119
Practice Address - Fax:503-228-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty