Provider Demographics
NPI:1275135436
Name:GARLOCK, NANCY L (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:GARLOCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 SW WILBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5658
Mailing Address - Country:US
Mailing Address - Phone:503-452-7616
Mailing Address - Fax:
Practice Address - Street 1:1040 NW 22ND AVE STE 600
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3041
Practice Address - Country:US
Practice Address - Phone:503-413-8165
Practice Address - Fax:503-413-8166
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist