MEDICARE: GAYLE MINER

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
1	183500000X	Pharmacist	RPH-0005859	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH-0005859	OTHER	OR	STATE PHARMACIST LICENSE

General Provider Information

NPI Number	:	1770856452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE MINER

Provider Business Mailing Address
First Line	:	1813 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4064
Country	:	US
Telephone Number	:	503-657-3187
Fax Number	:	503-655-8031

Provider Business Practice Location Address
First Line	:	1813 MOLALLA AVE
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4064
Country	:	US
Telephone Number	:	503-657-3187
Fax Number	:	503-655-8031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2012
Last Update Date	:	02/11/2012

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Directions to “ GAYLE MINER ” Practice Location

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