Provider Demographics
NPI:1760668636
Name:THORVILSON, STEVEN R (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:THORVILSON
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 WALLACE RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3116
Mailing Address - Country:US
Mailing Address - Phone:866-525-0583
Mailing Address - Fax:503-315-4034
Practice Address - Street 1:1160 WALLACE RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3116
Practice Address - Country:US
Practice Address - Phone:866-525-0583
Practice Address - Fax:503-315-4034
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103641835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist