Provider Demographics
NPI:1609680370
Name:VILLANUEVA, TRISHA TAN (PHARMD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:TAN
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 SW PLUMERIA WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1290
Mailing Address - Country:US
Mailing Address - Phone:971-712-9889
Mailing Address - Fax:
Practice Address - Street 1:4495 SW PLUMERIA WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-1290
Practice Address - Country:US
Practice Address - Phone:971-712-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist