Provider Demographics
NPI:1841541042
Name:FLAGG, REBECCA (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FLAGG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:FLAGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3225 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1912
Mailing Address - Country:US
Mailing Address - Phone:503-357-2034
Mailing Address - Fax:
Practice Address - Street 1:3225 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1912
Practice Address - Country:US
Practice Address - Phone:503-357-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0013160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0013160OtherSTATE PHARMACIST LICENSE