NPIMap

Organization Active NPI

Beaverton Pharmacy Inc

  • Community/Retail Pharmacy
  • Beaverton, OR
National Provider Identifier
1548217136
Registry record updated Dec 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RP-0000129-CS Issued in OR
Legal business name
BEAVERTON PHARMACY INC
Practice address
12250 SW Canyon Rd
Beaverton, OR 97005-2116
Phone
(503) 644-2101
Fax
(503) 626-8698
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas IrbyNPI 1598989311
Title
President
Phone
(503) 644-2101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X RP-0000129-CS OR Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

12250 SW Canyon Rd
Beaverton, OR 97005-2116

Mailing address

12250 SW Canyon Rd
Beaverton, OR 97005-2116
Phone (503) 644-2101

Other identifiers 2

IdentifierTypeStateIssuer
2148247OtherPK
007807MedicaidOR

Other names 1

  • Beaverton Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

12250 SW Canyon Rd
Beaverton, OR 97005
Phone (503) 644-2101

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1548217136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12250 SW CANYON RD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052116",
            "telephone_number": "503-644-2101",
            "fax_number": "503-626-8698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12250 SW CANYON RD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052116",
            "telephone_number": "503-644-2101",
            "fax_number": "503-626-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERTON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "IRBY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-644-2101"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0000129-CS",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148247",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007807",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaverton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaverton Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.