Healthcare Provider Details

I. General information

NPI: 1184621591
Provider Name (Legal Business Name): REGINALD ALLAN CAREY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SW 72ND AVE
PORTLAND OR
97224-7745
US

IV. Provider business mailing address

2015 NE LIBERTY ST
PORTLAND OR
97211-5338
US

V. Phone/Fax

Practice location:
  • Phone: 503-626-9436
  • Fax: 503-372-1792
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10504
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: