Healthcare Provider Details

I. General information

NPI: 1063746170
Provider Name (Legal Business Name): CHRISTOPHER CARTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 W POWELL BLVD
GRESHAM OR
97030-5050
US

IV. Provider business mailing address

4285 W POWELL BLVD
GRESHAM OR
97030-5050
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-2922
  • Fax: 503-492-8060
Mailing address:
  • Phone: 503-492-2922
  • Fax: 503-492-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11689
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33137
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: