Provider Demographics
NPI:1306096821
Name:DARRAH, PHILIP JAMES (RPH)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:DARRAH
Suffix:
Gender:M
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:PO BOX 129
Mailing Address - Street 2:660 S. MAIN ST.
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-0129
Mailing Address - Country:US
Mailing Address - Phone:503-324-5780
Mailing Address - Fax:503-324-5410
Practice Address - Street 1:622 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-1262
Practice Address - Country:US
Practice Address - Phone:503-429-0591
Practice Address - Fax:503-429-7209
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist