Provider Demographics
NPI:1316210016
Name:MCCARTHY, GLORIA REGINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:REGINA
Last Name:MCCARTHY
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 1:37655 GOLDENRAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36859 HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7213
Practice Address - Country:US
Practice Address - Phone:503-783-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR9881OtherSTATE PHARMACIST LICENSE