Provider Demographics
NPI:1932481991
Name:HAFEZ, NICHOLAS J
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:HAFEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 NE SHALEEN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6764
Mailing Address - Country:US
Mailing Address - Phone:503-268-6918
Mailing Address - Fax:503-268-6917
Practice Address - Street 1:7650 NE SHALEEN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6764
Practice Address - Country:US
Practice Address - Phone:503-268-6918
Practice Address - Fax:503-268-6917
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR76851835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist