Provider Demographics
NPI:1366314403
Name:REGASSA, FIREHIWOT G
Entity type:Individual
Prefix:
First Name:FIREHIWOT
Middle Name:G
Last Name:REGASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17495 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3212
Mailing Address - Country:US
Mailing Address - Phone:503-848-7700
Mailing Address - Fax:
Practice Address - Street 1:17495 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-3212
Practice Address - Country:US
Practice Address - Phone:503-848-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist