Provider Demographics
NPI:1841660461
Name:SIN, EKDARA (PHARMD)
Entity type:Individual
Prefix:
First Name:EKDARA
Middle Name:
Last Name:SIN
Suffix:
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 1:11863 SW GREENBURG RD APT 5
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6493
Mailing Address - Country:US
Mailing Address - Phone:541-281-9070
Mailing Address - Fax:
Practice Address - Street 1:11863 SW GREENBURG RD APT 5
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6493
Practice Address - Country:US
Practice Address - Phone:541-281-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0014964OtherPHARMACY LICENSE