Provider Demographics
NPI:1962800334
Name:ROYSTER, DAVID III
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROYSTER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 SW WASHO CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8350
Mailing Address - Country:US
Mailing Address - Phone:503-612-4871
Mailing Address - Fax:
Practice Address - Street 1:7401 SW WASHO CT
Practice Address - Street 2:SUITE #100
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8350
Practice Address - Country:US
Practice Address - Phone:503-612-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist