Provider Demographics
NPI:1457232761
Name:KOUKOUMANOS, PETER HRISTOS (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:HRISTOS
Last Name:KOUKOUMANOS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23500 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-9653
Mailing Address - Country:US
Mailing Address - Phone:503-667-1709
Mailing Address - Fax:
Practice Address - Street 1:23500 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD VILLAGE
Practice Address - State:OR
Practice Address - Zip Code:97060-9653
Practice Address - Country:US
Practice Address - Phone:503-667-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist