Provider Demographics
NPI:1639441231
Name:TRAFFAS, GARY DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DOUGLAS
Last Name:TRAFFAS
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 1:9450 SW WILSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7585
Mailing Address - Country:US
Mailing Address - Phone:503-582-1118
Mailing Address - Fax:503-582-1589
Practice Address - Street 1:9450 SW WILSONVILLE RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7585
Practice Address - Country:US
Practice Address - Phone:503-582-1118
Practice Address - Fax:503-582-1589
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist