Provider Demographics
NPI:1922536606
Name:PHARMACY ACQUISITION CO., LLC
Entity Type:Organization
Organization Name:PHARMACY ACQUISITION CO., LLC
Other - Org Name:NEWERA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TREHARNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:503-338-9840
Mailing Address - Street 1:1286 SE HOLGATE BLVD # C-2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5053
Mailing Address - Country:US
Mailing Address - Phone:503-222-4822
Mailing Address - Fax:503-222-4868
Practice Address - Street 1:1286 SE HOLGATE BLVD # C-2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5053
Practice Address - Country:US
Practice Address - Phone:503-222-4822
Practice Address - Fax:503-222-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336M0002X, 3336S0011X
ORRP-0000985-CS3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733435Medicaid