Provider Demographics
NPI:1609394998
Name:BAYNES, SAMUEL WEST III (RPH)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WEST
Last Name:BAYNES
Suffix:III
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 1:17255 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3297
Mailing Address - Country:US
Mailing Address - Phone:503-207-7632
Mailing Address - Fax:503-207-7628
Practice Address - Street 1:17255 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3297
Practice Address - Country:US
Practice Address - Phone:503-207-7632
Practice Address - Fax:503-207-7628
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60766529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist