Provider Demographics
NPI:1700186202
Name:CARLSON, DARIN
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15570 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3522
Mailing Address - Country:US
Mailing Address - Phone:503-598-6009
Mailing Address - Fax:503-598-6013
Practice Address - Street 1:15570 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3522
Practice Address - Country:US
Practice Address - Phone:503-598-6009
Practice Address - Fax:503-598-6013
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008825183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist