Provider Demographics
NPI:1154003416
Name:GADDA, MEGAN ALEXANDRA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALEXANDRA
Last Name:GADDA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALEXANDRA
Other - Last Name:BUELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20082 SW CEDAR GROVE LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2271
Mailing Address - Country:US
Mailing Address - Phone:503-314-5072
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist