Basic Information
| Provider Information | |||||||||
| NPI: | 1740410620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BZOWYCKYJ | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3808 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034133900 | ||||||||
| FaxNumber: | 5034133710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1960 NW 167TH PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970064805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036726000 | ||||||||
| FaxNumber: | 5036726001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2009 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 119735 | MN | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 2011024490 | MO | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 1835P1200X | 11371 | CT | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 183500000X | RPH-0017037 | OR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.