Provider Demographics
NPI:1568410736
Name:MATHRE, DAVID ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALBERT
Last Name:MATHRE
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 1:91924 HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-8531
Mailing Address - Country:US
Mailing Address - Phone:503-325-0698
Mailing Address - Fax:
Practice Address - Street 1:91924 HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-8531
Practice Address - Country:US
Practice Address - Phone:503-325-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008478183500000X
ORRPH-00084781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist