Provider Demographics
NPI:1508422486
Name:SAULLES, ADAM RORY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RORY
Last Name:SAULLES
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 1:6348 NE HALSEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4720
Mailing Address - Country:US
Mailing Address - Phone:503-962-1705
Mailing Address - Fax:
Practice Address - Street 1:6348 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4720
Practice Address - Country:US
Practice Address - Phone:503-962-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00153381835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60743255OtherWASHINGTON BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION
MST-14686OtherMISSISSIPPI BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION
MI5302038969OtherMICHIGAN BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION
ORRPH-0015338OtherOREGON BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION
VA0202215443OtherVIRGINIA BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION