Provider Demographics
NPI:1588173470
Name:WESLEY, DASHIELL ROSE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DASHIELL
Middle Name:ROSE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:DASHIELL
Other - Middle Name:ROSE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:12735 NW MAPLECREST WAY
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-6029
Mailing Address - Country:US
Mailing Address - Phone:503-929-6246
Mailing Address - Fax:
Practice Address - Street 1:6495 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8486
Practice Address - Country:US
Practice Address - Phone:503-848-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00162561835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist