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NPI Code Detail

MEDICARE: MR. WILLIS EUGENE CARMEN JR. R.PH.

MEDICARE: MR. WILLIS EUGENE CARMEN JR. R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist6722OR

General Provider Information

NPI Number : 1225338197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIS EUGENE CARMEN JR. R.PH.
Provider Business Mailing Address
First Line : 1128 SW 10TH DR
Second Line :
City : GRESHAM
State : OR
Zip : 97080-9679
Country : US
Telephone Number : 503-667-6626
Fax Number :
Provider Business Practice Location Address
First Line : 3527 SE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97236-3401
Country : US
Telephone Number : 503-760-6688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2010
Last Update Date : 10/26/2010

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