Provider Demographics
NPI:1689873242
Name:NEW SEASONS MARKET - HAPPY VALLEY
Entity Type:Organization
Organization Name:NEW SEASONS MARKET - HAPPY VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-558-9215
Mailing Address - Street 1:15861 SE HAPPY VALLEY TOWN CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-558-9215
Mailing Address - Fax:503-658-8470
Practice Address - Street 1:15861 SE HAPPY VALLEY TOWN CENTER DR.
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-558-9215
Practice Address - Fax:503-658-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002413-CS3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy