Provider Demographics
NPI:1508009093
Name:GOUGER, GARY R (RPH,OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:GOUGER
Suffix:
Gender:M
Credentials:RPH,OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 SE SHERLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2238
Mailing Address - Country:US
Mailing Address - Phone:503-442-3264
Mailing Address - Fax:
Practice Address - Street 1:8216 SE SHERLEY AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2238
Practice Address - Country:US
Practice Address - Phone:503-442-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3073ATI152W00000X
CA7201152W00000X
WA00003295152W00000X
WAPH00068682183500000X
OR0008670183500000X
CA31990183500000X
IL051031416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No152W00000XEye and Vision Services ProvidersOptometrist