Provider Demographics
NPI:1598470403
Name:IRBY PHARMACY, LLC
Entity Type:Organization
Organization Name:IRBY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-429-4646
Mailing Address - Street 1:12250 SW CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2116
Mailing Address - Country:US
Mailing Address - Phone:503-644-2101
Mailing Address - Fax:
Practice Address - Street 1:622 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-1262
Practice Address - Country:US
Practice Address - Phone:503-429-4646
Practice Address - Fax:503-429-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy