Provider Demographics
NPI:1790151306
Name:ORR, SHANE R (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:R
Last Name:ORR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NE 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6404
Mailing Address - Country:US
Mailing Address - Phone:503-791-9879
Mailing Address - Fax:
Practice Address - Street 1:17275 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3297
Practice Address - Country:US
Practice Address - Phone:503-207-7632
Practice Address - Fax:503-207-7628
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist