Provider Demographics
NPI:1396129565
Name:ABRAHAM, JOSEPH IV (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:ABRAHAM
Suffix:IV
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 NEWMARK AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4728
Mailing Address - Country:US
Mailing Address - Phone:541-888-5750
Mailing Address - Fax:541-888-9233
Practice Address - Street 1:2051 NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4728
Practice Address - Country:US
Practice Address - Phone:541-888-5750
Practice Address - Fax:541-888-9233
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0014680183500000X
ORRPH00146801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist