Provider Demographics
NPI:1740573351
Name:MANYRATH, USSAH
Entity Type:Individual
Prefix:
First Name:USSAH
Middle Name:
Last Name:MANYRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 SW 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9415
Mailing Address - Country:US
Mailing Address - Phone:503-307-2851
Mailing Address - Fax:
Practice Address - Street 1:1150 N SPRINGBROOK RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2007
Practice Address - Country:US
Practice Address - Phone:503-538-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist