Provider Demographics
NPI:1598989311
Name:IRBY, THOMAS WADE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WADE
Last Name:IRBY
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 1:12250 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:503-626-8698
Practice Address - Street 1:12250 SW CANYON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2116
Practice Address - Country:US
Practice Address - Phone:503-644-2101
Practice Address - Fax:503-626-8698
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005882183500000X
ORRPH-0014022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist