Provider Demographics
NPI:1710746458
Name:PNW PHARMACY LLC
Entity Type:Organization
Organization Name:PNW PHARMACY LLC
Other - Org Name:PNW RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEURANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-986-7827
Mailing Address - Street 1:400 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5604
Mailing Address - Country:US
Mailing Address - Phone:503-573-3278
Mailing Address - Fax:503-573-3270
Practice Address - Street 1:400 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5604
Practice Address - Country:US
Practice Address - Phone:503-573-3278
Practice Address - Fax:503-573-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty