Basic Information
| Provider Information | |||||||||
| NPI: | 1346473451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | BRADFIELD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 SE 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036017410 | ||||||||
| FaxNumber: | 5036017136 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 SE 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036017410 | ||||||||
| FaxNumber: | 5036017136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0010804 | OR | Y | Pharmacy Service Providers | Pharmacist | 183500000X | PH 00065072 | WA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.