Provider Demographics
NPI:1497459713
Name:CHA, BRANDON CHUYEE (RPH)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHUYEE
Last Name:CHA
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 1:10620 NE SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2651
Mailing Address - Country:US
Mailing Address - Phone:503-351-0785
Mailing Address - Fax:
Practice Address - Street 1:4346 NE CULLY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2206
Practice Address - Country:US
Practice Address - Phone:503-288-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist