Provider Demographics
NPI:1093201865
Name:DELANDER, GARY EUGENE
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EUGENE
Last Name:DELANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 NW ALDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9102
Mailing Address - Country:US
Mailing Address - Phone:541-745-7314
Mailing Address - Fax:
Practice Address - Street 1:1114 NW ALDER CREEK DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9102
Practice Address - Country:US
Practice Address - Phone:541-745-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist