Provider Demographics
NPI:1427604297
Name:ENFIELD, BRADEN JEFFREY (RPH)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:JEFFREY
Last Name:ENFIELD
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 1:2080 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1484
Mailing Address - Country:US
Mailing Address - Phone:541-753-2226
Mailing Address - Fax:541-753-2559
Practice Address - Street 1:2080 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1484
Practice Address - Country:US
Practice Address - Phone:541-753-2226
Practice Address - Fax:541-753-2559
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0017381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0017381OtherSTATE RPH LICENSE