Provider Demographics
NPI:1558594739
Name:SEEBECK, DARIN RAY (RPH)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:RAY
Last Name:SEEBECK
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 1:1944 SW 20TH CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5791
Mailing Address - Country:US
Mailing Address - Phone:503-661-6358
Mailing Address - Fax:503-492-8060
Practice Address - Street 1:4285 W POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5050
Practice Address - Country:US
Practice Address - Phone:503-492-2922
Practice Address - Fax:503-492-8060
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist