Healthcare Provider Details

I. General information

NPI: 1871677609
Provider Name (Legal Business Name): MARVIN CARL STURGEON B. PHARM.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MONTE STURGEON B. PHARM.

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW JEFFERSON ST
PORTLAND OR
97201-3425
US

IV. Provider business mailing address

3326 NE COUCH ST
PORTLAND OR
97232-3233
US

V. Phone/Fax

Practice location:
  • Phone: 503-205-1860
  • Fax: 503-205-1849
Mailing address:
  • Phone: 503-233-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0006937
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011046
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0006937
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: