Provider Demographics
NPI:1720334816
Name:DITMARSON, BETH (RPH)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DITMARSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16787 SW WHITETAIL LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6480
Mailing Address - Country:US
Mailing Address - Phone:503-701-7948
Mailing Address - Fax:
Practice Address - Street 1:7216 SW DURHAM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7594
Practice Address - Country:US
Practice Address - Phone:503-718-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6587183500000X
CA32754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist