Provider Demographics
NPI:1922371624
Name:SAUVAGEAU, DOUGLAS WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:SAUVAGEAU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 SW PACIFIC HWY
Mailing Address - Street 2:70
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4804
Mailing Address - Country:US
Mailing Address - Phone:503-624-0713
Mailing Address - Fax:503-639-4011
Practice Address - Street 1:13500 SW PACIFIC HWY
Practice Address - Street 2:70
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4804
Practice Address - Country:US
Practice Address - Phone:503-624-0713
Practice Address - Fax:503-639-4011
Is Sole Proprietor?:No
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist