Healthcare Provider Details

I. General information

NPI: 1326311374
Provider Name (Legal Business Name): BRANDON THORESON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61535 S HWY 97
BEND OR
97702-2154
US

IV. Provider business mailing address

61535 S HWY 97
BEND OR
97702-2154
US

V. Phone/Fax

Practice location:
  • Phone: 541-385-6658
  • Fax:
Mailing address:
  • Phone: 541-385-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH12537
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12537
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: