Provider Demographics
NPI:1124216445
Name:DOUGHTON, BOBBI ERIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:ERIN
Last Name:DOUGHTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:ERIN
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:600 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3202
Mailing Address - Country:US
Mailing Address - Phone:503-227-4835
Mailing Address - Fax:503-227-2378
Practice Address - Street 1:600 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3202
Practice Address - Country:US
Practice Address - Phone:503-227-4835
Practice Address - Fax:503-227-2378
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-14667183500000X
UT5566092-1701183500000X
ORRPH-00147321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist