Provider Demographics
NPI:1114369287
Name:CARSON, DEAN LUCAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:LUCAS
Last Name:CARSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3090
Mailing Address - Country:US
Mailing Address - Phone:503-452-3033
Mailing Address - Fax:503-452-3027
Practice Address - Street 1:3740 MARKET ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1826
Practice Address - Country:US
Practice Address - Phone:503-370-4351
Practice Address - Fax:503-370-4892
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0013170183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist