Provider Demographics
NPI:1427801406
Name:TREHARNE, ED JR (RPH)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:TREHARNE
Suffix:JR
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 1:1319 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3995
Mailing Address - Country:US
Mailing Address - Phone:503-325-4541
Mailing Address - Fax:503-325-6827
Practice Address - Street 1:1319 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3995
Practice Address - Country:US
Practice Address - Phone:503-325-4541
Practice Address - Fax:503-325-6827
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0000087-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy